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Social Security Form SSA-3373-BK


Applying for Social Security disability benefits can be a long process. It can involve interviews, multiple applications and sometimes rejections and appeals. The Social Security Administration (SSA) needs to determine both that your injuries or conditions are actively preventing you from working and that they’ll continue to do so for some time. To determine this, the SSA needs a lot of information from you. One way you provide this information is through Form SSA-3373-BK. Consider working with a financial advisor as you do retirement planning.

What Is Form SSA-3373-BK?

Social Security Form SSA-3373-BK is a lengthy form that you fill out as a part of the process of applying for Social Security Disability benefits. It also goes by the Adult Disability Report or the Adult Function Report.

Typically, the process of applying for disability begins with you filing an initial claim for benefits and submitting a Form SSA-827 to release your medical records. If those medical records don’t provide enough information to make a decision, then the SSA will typically ask you to fill out Form SSA-3373-BK. Some states, however require the form for all applicants.

How to Fill Out Form SSA-3373-BK: Sections A & B

Form SSA-3373-BK is 10 pages long and split into five sections. You may not have an answer to every question, but don’t leave anything blank. If you don’t know the answer or you don’t have one, write “don’t know” or “none” instead.

Section A is for basic information like your name, Social Security number (SSN), phone number and living situation. Section B is where you’ll list all the different ways your condition(s) inhibit your ability to work a full-time job. With this section, it’s in your best interest to be as detailed and specific as possible. If you have multiple injuries or illnesses that are keeping you from work, list everything. This section is where you can make your case for why you need disability benefits.


How to Fill Out Form SSA-3373-BK: Sections C – E

Section C is the longest section in the form. With this section, the SSA is trying to get a sense of how you perform a wide range of daily activities. First, you’ll need to list everything you do from when you wake up to when you go to bed. After that, you’ll have to answer 13 other questions about your life, including:

  • If you take care of children and/or pets
  • How you sleep
  • If you can feed yourself and prepare your own meals
  • Whether you can drive
  • Your hobbies and interests

In the next section, you’ll answer a range of questions about your ability to perform certain actions. This is similar to section C, but more task-focused and less about your daily life. You’ll have to describe how your disability affects a range of activities like lifting, talking and concentration. You’ll also need to answer questions about how well you follow instructions, if you can pay attention long enough to finish conversations or chores and how you handle stress and changes in routine. You can also list any medications you’re taking here.

The final section is for you to add any last remarks that you didn’t add in any other section of the form. If you feel you have more compelling evidence that you didn’t express in Section B or in your answers to the questions in Sections C and D, this is the place for it. Once you’ve written everything you wish to write, just add your name and address to the bottom of the form.

How to Submit Form SSA-3373-BK

When you’ve completed every part of the form and you’re satisfied with your answers, you can either mail or fax your form to your local Social Security office. To find the address or fax number of your office, you can head to the Social Security website. You can also call the customer service line at 1-800-772-1213.


Bottom Line

Social Security Form SSA-3373-BK is a crucial part of your application for disability benefits. With it, you can provide the information necessary for the SSA to make an educated decision regarding your eligibility for benefits. Because of this, it’s very important for you to take your time. Be sure to include every detail you can. By doing so, you can give yourself the best possible chance of receiving the benefits you need.

Tips for Managing Your Finances

  • Even with Social Security disability benefits, disability can severely tax your finances. That’s why having an emergency fund can be such a big help in stressful times. If you save ahead of time, you can protect yourself from the unexpected.
  • One of the many stressful consequences of a disability is that you may have to dip into your retirement savings to pay medical your bills. SmartAsset’s retirement calculator can help you make sure you’re still on track. Just enter the necessary information, and the calculator will give you a customized monthly savings target.
  • If you’re worried about the financials of your recovery or you just want some peace of mind, you should talk with a financial advisor. If you don’t have a financial advisor yet, finding one doesn’t have to be hard. SmartAsset’s free tool matches you with up to three vetted financial advisors who serve your area, and you can interview your advisor matches at no cost to decide which one is right for you. If you’re ready to find an advisor who can help you achieve your financial goals, get started now

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