TN 11 (06-04)
DI 11005.026 Completing the SSA-3373-BK (Function Report – Adult)
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.
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).