Effective Dates: 06/20/2007 - Present Previous | Next

TN 11 (06-04)

DI 11005.026 Completing the SSA-3373-BK (Function Report – Adult)

A. Policy

Use the SSA-3373 to collect information about a claimant's ability to function and to perform the activities of daily living.The information detailed on the SSA-3373 may be obtained by telephone and recorded on an SSA-5002 in lieu of using the SSA-3373. Supplemental information may be added to the SSA-3373.

B. Procedure

1. When to Complete

The FO must complete an SSA-3373 only for someone who:

  • •

    Is homeless; or

  • •

    Will be difficult to contact by telephone; or

  • •

    Will be unavailable for contact (e.g., may be on an extended trip).

2. When not to complete

The FO does not complete the SSA-3373 when SSA-3368 curtailment is applicable (see DI 11005.020).

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0411005026
DI 11005.026 - Completing the SSA-3373-BK (Function Report – Adult) - 06/20/2007
Batch run: 04/25/2014
Rev:06/20/2007