The DDS determines when to develop symptoms of pain and sends the form to collect the information. The form records information on the location, duration, frequency, and intensity of pain, the precipitating and aggravating factors, and …

On the SSA-3373-BK (Function Report – Adult), an individual says they can only walk a few blocks due to pain. The medical evidence includes a knee x-ray showing moderate degenerative changes and a physical exam indicating limited range …

In evaluating the intensity and persistence of your symptoms, including pain, we will consider all of the available evidence, including your medical history, the medical signs and laboratory findings, and statements about how your symptoms affect you.

2024年2月14日 · Form Pain Questionnaire Pain Questionnaire Pain Questionnaire Disability Case Development Information Collections Category III - Pain, Other Symptoms, Impairment Information - Revised Category III - Pain/Other Symptoms/Impairment Information OMB: 0960-0555. OMB.report. SSA. OMB 0960-0555.

Pain Questionnaire 1. Describe where pain is located. Does it stay in one location or move to other areas of your body? Sample answer 1: I have constant back pain that is located in the mid to right side of my lower back. This is consistent with my L5/S1 stenosis and bulging disc diagnosis. If I “overdo” daily

2022年7月7日 · If you have long-term, chronic pain that's caused by an MDI, Social Security will assess whether your impairment qualifies for Social Security disability insurance (SSDI) or SSI disability benefits.

2023年4月3日 · To complete the questionnaire, follow these steps: Read the questions carefully and answer them truthfully. Be as specific as possible in your answers and provide examples if necessary. Use descriptive words to describe the intensity of your pain, such as mild, moderate, severe, or unbearable.

State disability determinations services collect the information SSA needs to administer our disability program. For the purposes of this ICR, we divide this information into three categories: 1) consultative examinations (a/b/c); 2) medical evidence of record; and 3) pain/other symptoms/impairment.

2013年10月9日 · Although, it may be difficult to describe your pain, The Social Security Administration (SSA) will try their best to get a description of your pain through form M44P, a Pain Questionnaire. A Pain questionnaire is needed as each person suffering from pain may be experiencing the pain differently.

Pain Questionnaire Clearance of Information Collections Conducted by State Disability Determination Services on Behalf of SSA OMB: 0960-0555 IC ID: 181780. OMB.report