Step 1: Understand the Purpose of the Form

Form SSA-3441 BK is commonly used when the SSA asks for a Continuing Disability Review (CDR). This means the SSA will periodically review whether your disability still qualifies you for ongoing benefits. You may receive this form if the SSA wants an update on your condition or activities. The form collects:

• Your current medical condition and how it impacts your ability to work.
• Any changes to your work history or income.
• Updates on your treatment and medications.

Step 2: Gather Required Information

Before you start filling out the form, make sure you have the following information on hand:

• Medical records related to your current condition (doctor’s notes, test results, etc.).
• Details of any treatments or therapies you’ve received.
• Work history or any information about any part-time or full-time work you’ve done.
• Information about any new health providers who are treating you.

Step 3: Complete Part 1: Personal Information

In this section, you will need to provide your personal details.

• Name: Your full name as it appears on your Social Security records.
• Social Security Number (SSN): Your full SSN.
• Date of Birth: The month, day, and year of your birth.
• Telephone Number: Provide your current phone number.
• Mailing Address: The address where the SSA can send correspondence.

Step 4: Complete Part 2: Information About Your Disability

In this part, you will need to explain any changes in your condition and how they affect your ability to work.

• Describe any medical treatments you’ve had since your last review.
• Include information about hospitalizations, medications, surgeries, or any physical therapy you’re currently undergoing.
• Be sure to provide the names of doctors or specialists treating your condition and details of any tests or procedures you’ve had.

• Work information:
• If you’ve worked during the period covered by the review, include details about your employment, including dates and job duties.
• If you’re unable to work, explain how your disability prevents you from doing so.

• How your condition affects your work: Describe how your disability impacts your ability to perform your job and daily tasks. For example, do you experience pain, fatigue, or difficulty concentrating? Be as specific as possible about the limitations caused by your condition.

Step 5: Complete Part 3: Treatment Information

Here, you will need to provide a detailed list of any treatments or medications you’ve been receiving.

• List any new treatments or medications you are taking.
• Include the names of any doctors or specialists who are involved in your treatment, as well as the address and phone numbers of the medical facilities.
• Provide details about any hospitalizations or treatments you have had since your last report.

Step 6: Complete Part 4: Work Activity (if applicable)

In this section, you must report any work activity since the last time you received benefits or since your last review.

• If you’ve worked at all (including part-time work or self-employment), provide details about the work, including your job title, the dates you worked, your duties, and your monthly earnings. Even if your work was part-time or occasional, the SSA needs this information to determine whether you are still eligible for benefits.
• If you have not worked, you should state that and explain why you have not been able to.

Step 7: Complete Part 5: Signature

After completing the form, you’ll need to sign and date the form to certify that the information you’ve provided is accurate and complete.

• Signature: Sign your name as you would on a legal document.
• Date: Write the date you signed the form.
• Contact Information: If someone else helped you fill out the form, include their information in this section.

Step 8: Review the Form

Before submitting the form, make sure to:

• Review all the information you provided to ensure accuracy.
• Double-check for any missing details or signatures.
• Ensure that you’ve included all supporting documentation, such as medical records or work history.
• If there are any parts of the form that do not apply to your situation, make sure to indicate that (such as marking it as "N/A" or "Not Applicable").

Step 9: Submit the Form

Once you’ve completed and reviewed the form:

• Mail the form to the address provided by the SSA. Typically, you will receive an address on the form itself.
• If you received the form online, you can often submit it electronically via your My Social Security account.

If you need additional assistance, you can contact the SSA at 1-800-772-1213 or visit a local Social Security office for guidance on filling out and submitting the form.