Form SSA-3373-BK. Function Report - Adult

Form SSA-3373-BK, the Function Report for Adults, serves as a detailed questionnaire that adults with disabilities or impairments can use to describe their abilities and limitations in daily activities. The primary purpose of this form is to gather information about an individual's physical and mental functioning to assist the Social Security Administration (SSA) in evaluating disability claims.

For example, when an adult applies for Social Security disability benefits due to a medical condition, they may need to complete this form to provide a comprehensive account of their daily functioning and limitations. The purpose is to help the SSA assess the severity of the disability and determine eligibility for benefits.

The parties involved are individuals with disabilities applying for Social Security benefits and the SSA. The form consists of sections related to personal information, daily activities, and specific questions about the individual's abilities and limitations. Accurate and detailed completion is crucial for the SSA to make an informed decision about disability benefits.