SSA-3380-BK - Function Report- Adult Anyone who makes or causes to be made a false statement or representation of material fact for use in determining a payment under the Social Security Act, or knowingly conceals or fails to disclose an event with an intent to affect an initial or continued right to payment, commits a crime punishable under Federal law by fine, imprisonment, or
California Code of Regulations, Title 8, Section 3380. Personal . . . (d) The employer shall assure that all required safety devices and safeguards, whether employer or employee provided, including personal protective equipment for the eyes, face, head, hand, foot, and extremities (limbs), protective clothing, respiratory protection, protective shields and barriers, comply with the applicable Title 8 standards and
FUNCTION REPORT Form SSA-3380-BK READ ALL OF THIS INFORMATION BEFORE . . . HOW TO COMPLETE TElS FORM The information that you give on this form will be used to make a decision on the disabled person's claim You can help by completing as mu of the farm as you can When a question ders to the "disabled ~n," it refers to the pason who is applying fbr or receiving disdility benefits
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