Form SSA-3368-BK. Disability Report - Adult
Form SSA-3368-BK, titled "Disability Report - Adult," is a document used in the disability claim process administered by the Social Security Administration (SSA) in the United States. This form is designed to gather essential information from individuals who are applying for disability benefits based on their inability to work due to a medical condition. The information provided in this report helps the SSA evaluate the applicant's eligibility for disability benefits.
Purpose: The primary purpose of Form SSA-3368-BK is to collect detailed information about the applicant's medical condition, work history, and other relevant factors that impact their ability to work. The information collected in this form assists the SSA in making informed decisions about whether the applicant meets the criteria for disability benefits according to the guidelines outlined in the Social Security Act.
Completion Process: Applicants are required to complete Form SSA-3368-BK by providing accurate and comprehensive responses to the questions posed in the form. The questions cover various aspects of the applicant's medical history, work history, and current capabilities. It also includes inquiries about the applicant's ability to perform daily tasks and engage in gainful employment. Applicants are instructed to answer all questions unless otherwise indicated and to provide additional explanations or information where necessary.
Assistance and Submission: Applicants who require assistance in completing the form can seek help from friends, family members, or Social Security Representatives. However, healthcare providers are not to be involved in filling out the form. The completed form can be submitted to the SSA office through scheduled appointments or by mail, as instructed.
Medical Records and Authorization: Applicants are encouraged to provide any available medical records that support their disability claim. However, the form clarifies that applicants do not need to independently request medical records from doctors or hospitals. With the applicant's authorization, the SSA will initiate the process of obtaining relevant medical records to assess the applicant's medical condition and disability status accurately.
Privacy and Use of Information: The form includes a Privacy Act Statement that outlines the legal basis for collecting personal information and how that information will be used. The information collected on the form is used for the purpose of evaluating the disability claim and making decisions regarding eligibility for benefits. The SSA may also disclose information to other entities as permitted by approved routine uses, including assisting third parties in determining eligibility for benefits and facilitating statistical research.
Definition of "Disability": The form provides a concise explanation of the term "disability" in the context of Social Security. It clarifies that disability refers to the inability to engage in any form of work as defined by the Social Security Act. The duration of the disability is also explained, indicating that it must last for at least one year or result in death to be considered for disability benefits.
Paperwork Reduction Act Statement: The form includes a statement explaining that completing the questions is not mandatory unless a valid Office of Management and Budget control number is displayed. The estimated time required to complete the form is provided, and instructions are given on how to submit the completed form.
Contact Information: The form concludes with information on how to locate local Social Security offices and how to contact the SSA for inquiries or comments regarding the form's time estimate.
In summary, Form SSA-3368-BK serves as a comprehensive tool for applicants to provide relevant information about their medical condition and work history to support their disability claim. The completed form is a crucial component of the disability benefits application process, aiding the SSA in evaluating the applicant's eligibility for financial assistance due to their inability to work.