SSA Form SSA-3373-BK

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SSA Form SSA-3373-BK

Every person has to work on a regular basis to be able to provide for his living before he is appointed an old-age pension. However, in some unpredictable cases, anyone can lose the ability to perform his usual working task, completely or partially. This sorrowful situation may happen to every person, both for natural reasons and due to accidental events. In any situation of this kind, a man suddenly becomes helpless and unprotected, and in most cases, without a livelihood.

The state applies substantial efforts to protect the taxpayers in difficult living situations of this kind and offers various guaranteed support programs. There are several state agencies responsible for all the issues connected with the social protection of citizens, and here we will focus on the Social Security Administration. One of the legal forms you have to submit to gain the disability benefit is the 3373-BK.

What Living Situations Does This Form Cover?

You may lose your ability to work and to earn a regular salary in the following most common situations:

  • A serious and long-lasting illness that inevitably leads to irreversible and cureless consequences for your health status.
  • An injury or wound, wherever it happens – at work, at home, or in any other circumstances.
  • The changes caused by your age happen to every person individually.

All these occasions can be subject to the disability benefits assignment. Be ready to apply some effort and devote enough time to collecting the documents and filling out the 3373 Form. The SSA examines every event thoroughly; therefore the honest and complete information about your disease will be of great help in achieving positive results.

Anyway, two main points are absolutely necessary to keep in mind:

  • Your health status must change to such an extent that you are unable to perform the activities you were able to execute before.
  • This sad situation must exist for at least one year continually.

Where to Start From

Usually, when a disability of any kind and severity occurs, you first have to complete another form to inform the social security agencies about your need to receive state support. That is the SSA-827, which always comes before the form we are talking about here. It is not as long and profound as the 3373-BK and contains almost no details except your personal data. In fact, it is needed only to express and confirm your agreement to make any information concerning your health condition and details of your treatment available to any state authorities in charge. After your voluntary consent is received, the social security system starts working with your disability case.

Why is This Form Important?

It frequently happens so that your medical documents and appointments for treatment contain scarce information for making an informed decision on whether you are really disabled and certainly need the state’s support on a constant basis or not. That is why the Social Security Administration may request additional data from you to form a complete and profound impression about your life and ability to function independently.

Therefore, as soon as you get this request, it is in your own interest to fill this form out and send it back at the appointed time. Certainly, this form is long and detailed and may cause certain difficulties for completion, especially when you have some health problems of any kind. In this case, you may use our form-filling editor, which can guide you step-by-step and certainly help you to avoid any sad mistakes. Use our form building-software and save your time and efforts!

The Main Points to Consider about SSA-3373

Before you decide to fill out the disability benefits form, try to memorize the following crucial points, as they are essential for a positive result:

  1. You must fill out all this form by yourself. You may ask for some advice, if necessary, but each letter in this document should be written by your hand.
  2. Fill all the boxes and lines there, do not leave anything empty. If you do not know what to answer, indicate it anyway.
  3. When you need to explain or add something, use the appropriate sections in the form. The more detailed your answers are, the better for you!
  4. Try to be as honest and logical as possible. Your primary task is to describe your current status and prove why you are not able to perform the actions necessary for self-service and self-sufficiency. Emphasize your problems and concentrate on your limitations more than on your abilities.
  5. Be sure to leave a completed copy for yourself after you come to an end and sign it.

After you have successfully coped with this task, you have the opportunity to send this questionnaire by mail or fax to your local social security office. The address and the fax number are available on the website of this service. The telephone support line is always at your disposal too.

Other SSA Forms

Should you wish to check out more SSA documents that you can edit and fill out online, listed here are a number of the more popular forms among our users. Moreover, do not forget that you may upload, fill out, and edit any PDF at FormsPal.

Step-by-step Recommendations to Fill out SSA-3373

The form includes ten pages and consists of five sections. Fill out all the boxes and lines attentively, even if you do not know what to answer specifically, tell about it, and add further explanations, if necessary.

Write in Your Personal Information

step 1 write in your personal information filling out a form ssa 3373 bk
This section is to indicate your name, the social security number, telephone for the daytime calls (if you can give it), your place of living, and any person living together with you. Fill in only one of the boxes on every line.

Describe Your Health Condition

step 2 describe your health condition filling out a form ssa 3373 bk
Section B is to describe all your illnesses, injuries, or any other health conditions preventing you from regular work or making it complicated. Do your best to be as detailed and comprehensible as possible. It will certainly affect the final decision to grant you the disability pension or not.

Tell About Your Daily Routine, Activities, and Occupations

step 3 tell about your daily routine, activities, and occupations filling out a form ssa 3373 bk
Primarily, describe all the activities you usually perform throughout the whole day. Just tell in a free form about everything you remember. If you take care of any other persons or pets, and someone helps you to carry out these home duties, write about it too.

Describe How Your Illnesses or Injuries Inflicted on Your Regular Abilities

step 4 describe how your illnesses or injuries inflicted on your regular abilities filling out a form ssa 3373 bk
Here you may cheer on the impossibility to perform any activities you were able to do before. Describe in what way these limitations are caused by your illnesses, injuries, or any other health problems. The same relates to problems with your personal care; fill out all the boxes in the list. If you do not find any problems with self-service, start with this answer.

Explain How You Manage to Cook and Perform Your Household Duties

step 5.1 explain how you manage to cook and perform your household duties filling out a form ssa 3373 bk
Here you may concentrate on any details connected with your favorite food preparation.

step 5.2 explain how you manage to cook and perform your household duties filling out a form ssa 3373 bk
Your ability to carry out any household chores may be of a certain interest, too, as well as any of your outdoor activities.

Answer Some Questions About Shopping and Getting Around

step 6 answer some questions about shopping and getting around filling out a form ssa 3373 bk
Indicate here if you are still able to go outside and travel anywhere. Clarify what places you prefer to visit, whether you can do it yourself and what means of transportation you usually prefer. Your ability to drive a car can add some useful information about your health condition too.

Pay Attention to Your Interests and Social Activities

step 7 pay attention to your interests and social activities filling out a form ssa 3373 bk
Describe your hobbies and interests here, with a special emphasis on any changes in these activities caused by your current disability.

Explain the Changes in Your Abilities to Perform Any Movements or Tasks

step 8 explain the changes in your abilities to perform any movements or tasks filling out a form ssa 3373 bk
This section is especially important for the understanding of your health status at present, what ordinary abilities you have lost, and to what extent. Do your best to explain how those changes are connected with your illnesses and to what degree. For example, the ability to keep the attention and complete any work from the beginning to the end is very important for the profound impression about your health.

Point Out What Mobility Aids You Have to Use

step 9 point out what mobility aids you have to use filling out a form ssa 3373 bk
If you need any aids like the walker or the wheelchair, or maybe the hearing aid or an artificial voice box to move or communicate, be sure to indicate it here.

List the Medicines You Currently Take

step 10 list the medicines you currently take filling out a form ssa 3373 bk
Here you need to list the medicines you use to take now for the treatment of your disabilities only if they produce any side effects. In this case, you have to describe what exactly you feel and due to what concrete medicine this or that side effect appears.

Add Any Details You Missed Above and Complete This Form

step 11 add any details you missed above and complete this form filling out a form ssa 3373 bk
In the last empty section of this document, you may add anything concerning the points you have filled out on the previous pages. When you cope with this task, pay special attention to the lower lines on the page.

Sign and date the questionnaire, put on your name, and indicate the place of living. Check the whole document attentively because you have an opportunity to use our form-building software again to be sure that everything is correct. Make a copy for yourself, and now it is possible to send your application to the service.