How to Fill Out Social Security Form 3373-BK

Related Articles

In the United States, disabled adults and children are eligible for Social Security benefits. Among the required paperwork is Social Security Form 3373-BK, or Function Report, which gives the Social Security Administration (SSA) the necessary information to make a decision regarding your disability claim. It's important to fill the form out correctly to ensure that the SSA can make the most informed decision possible regarding your case.

Read the Privacy Act and Paperwork Reduction Act Statements, located at the beginning of the 3373-BK document.

Write the answers on a printed copy of Form 3373-BK or type the information into an electronic form (see Resources).

Enter your name, Social Security number, contact information and where and with whom you live with into Section A.

Describe your daily activities in Section B. Provide information about your daily routine, the impact of your disability on these activities, any parties you care for and any assistance you receive. Check off the appropriate responses to questions about your personal care, house and yard work, transportation, meals, shopping, finances, hobbies and social activities.

Provide answers to questions about your physical and mental abilities in Section C.

Use the "Remarks" section (D) at the end of the document if you require additional space to answer a question. Include the relevant question number next to any information provided in this section. You also can use this section to provide any additional information you think might be relevant and useful in evaluating your case.

Write "Don't Know," "Does Not Apply" or "None" if you are unable to answer a question or if a question does not apply to your case.

Return the 3373-BK form to the office that instructed you to complete it. Contact Social Security (see Resources) if you do not know the address of the office that requested your 3373-BK form.


  • For more in-depth advice about filling out Form 3373-BK, consult the Disability Workbook for Social Security Applicants (see Resources).


About the Author

Aksana Nikolai is a graduate of the New York Institute of Technology with a bachelor's degree in language studies and international affairs. Nikolai is currently working in online marketing and communications. She has been writing since 2008, specializing in made-for-Web content and maintaining her fashion and beauty blog.