SSA 3375 BK - Jan 2022

The SSA 3375 BK form provides information about an individual's ability to perform activities of daily living and work-related activities. Individuals who are applying for Social Security disability benefits and need to provide this information can fill out this form and submit it to the Social Security Administration.

Individuals applying for Social Security disability benefits need to provide information about their ability to perform activities of daily living and work-related activities.

The completed form should be submitted to the Social Security Administration.