How to Fill Out the Social Security Function Report (Form SSA-3373)

What is the Social Security Function Report (SSA-3373)?

It is a questionnaire titled Function Report, Adult, that asks how your illnesses, injuries or conditions affect what you do each day. The current form runs ten pages, and Social Security estimates it takes about 61 minutes to read the instructions, gather the facts and answer the questions. It is part of the evidence in a claim for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) when you apply for disability.

Social Security's operating manual, POMS DI 11005.026, tells field office staff to complete the form themselves only for a claimant who is homeless, will be difficult to contact by telephone, or will be unavailable for contact, such as during an extended trip.

The form has five parts. Section A covers basic information and where you live. Section B asks how your conditions limit your ability to work. Section C covers daily activities, Section D covers your abilities, medicines and any devices you use, and Section E is a Remarks section for anything that did not fit elsewhere.

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How Social Security uses your Function Report in a disability claim

Social Security reads the Function Report as your statement about your symptoms and then tests it against everything else in the file. Under 20 CFR 404.1529, statements about pain or other symptoms will not alone establish that you are disabled, and the first factor the regulation lists for evaluating symptoms is your daily activities. That is what Section C asks about.

The comparison is spelled out in Social Security's manual on evaluating symptoms, POMS DI 24501.021. Adjudicators compare what you say in connection with your claim, such as on the SSA-3373 or at a consultative exam, with what you said in other settings, such as to your own doctors. They must give specific reasons when they assess the intensity, persistence and limiting effects of your symptoms. The manual also says your statements about the intensity and persistence of symptoms will not be rejected solely because objective medical evidence does not confirm them.

Treatment history enters the picture too. The same manual section says frequent attempts at treatment may show that symptoms are intense and persistent, and that a lack of treatment may show the opposite. It also lists other things a lack of treatment may show, such as being unable to afford care or stopping a medicine whose side effects are harder to tolerate than the symptoms. If there is a reason you stopped a treatment or could not afford one, the Function Report is a place to say so.

Think of the form as a statement the adjudicator will read alongside your medical records. Where the two tell the same story, the Function Report fills in what a chart cannot show: how long you can stand at the sink, whether you need reminders to take medicine, what happens to the rest of your day after a trip to the store. The limits you describe are weighed with the medical evidence when Social Security assesses your residual functional capacity.

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What each section of the Function Report asks about your disability

Most of the form is Sections C and D, and each question is narrower than it first looks.

• Daily activities (Section C): your routine from waking to bedtime, care for others or pets, what you could do before your conditions that you cannot do now, and how your sleep is affected.
• Personal care: dressing, bathing, hair care, shaving, feeding yourself and using the toilet, and whether you need reminders for personal care or medicine.
• Meals, house and yard work: what you prepare, how long it takes, which chores you do and whether someone helps.
• Getting around and shopping: how often you go out, whether you drive or go out alone, and where, what and how often you shop.
• Money, hobbies and social activities: paying bills and handling savings, your interests and how they have changed, and how you spend time with others.
• Abilities (Section D): a checklist of 19 abilities, including lifting, standing, walking, sitting, reaching, using your hands, memory, concentration, understanding, following instructions and getting along with others, followed by how far you can walk, how long you can pay attention, how you handle stress and changes in routine, and any unusual behavior or fears.
• Devices and medicines: crutches, a cane, a walker, a wheelchair, glasses or a hearing aid, whether a doctor prescribed each one, when it was prescribed and when you need to use it, plus whether you take medicines for your conditions and which ones cause side effects.

Every checked box in Section D asks you to explain how the condition affects that ability, so a check mark without a sentence beside it leaves the most useful part blank.

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How to answer Function Report questions so your claim reads accurately

Answer with specifics drawn from an ordinary week. The form itself asks for numbers in places, such as how many pounds you can lift and how far you can walk before you stop to rest, and numbers help in other answers too: how many minutes you can stand, how many times a week a bad day keeps you in bed, how long a shower takes and whether you sit down partway through.

The form's own instructions tell you not to leave answers blank and, when an activity is done with someone else's help, to say so. That second instruction matters more than it seems. If your spouse carries the laundry, your daughter drives you to appointments or a neighbor sets out your pills, write it down, because an activity you finish only with help is a different fact from one you do on your own.

Describe both your usual pattern and your bad days, and say how often the bad days happen. A form that describes only the good days understates the limits, and one that describes only the worst day can read as inconsistent with medical notes taken on better days. Keep your answers consistent with what you have told your doctors, since that is the comparison the adjudicator makes.

List side effects of your medicines, such as drowsiness or nausea, and for any device you use, say whether a doctor prescribed it, when, and when you need to use it. The form carries a warning that knowingly making a false statement is a federal crime, so accuracy protects you twice: it keeps the claim credible and keeps you on the right side of the penalty statement. If you run out of room, the Remarks section in Section E takes the overflow; note which question each remark continues.

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The third-party Function Report (SSA-3380) and who should fill it out

Social Security also accepts a version completed by someone who knows you, the Function Report, Adult, Third Party, Form SSA-3380. The regulation on symptoms says Social Security considers evidence from nonmedical sources about how your symptoms affect you, which is the role this form plays.

The third-party form asks how long the person has known you and how much time you spend together, then covers the same ground as your own report: daily routine, personal care, chores, getting around, money, social activities and abilities. Its instructions tell the person completing it not to ask you for the answers, and not to hand it to a doctor or hospital. The value of the form is a second, independent account from someone who sees your days firsthand.

A spouse, adult child, close friend or former coworker who sees you regularly is usually a better choice than someone who knew you well years ago. What matters is what they have observed, written in their own words.

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Returning the Function Report and what happens if a disability claim lacks it

The form instructs you to send or bring the completed report to your local Social Security office, and to remove the sheet with the Privacy Act statement before returning it. The form itself does not print a deadline, so if a letter that came with it gives a return date, treat that date as the deadline, and call the number on the letter if you need more time.

Leaving it unreturned has a cost. Under 20 CFR 404.1512, if Social Security asks, you must tell it about your daily activities both before and after the date you say you became disabled. Under 20 CFR 404.1516, if you do not provide the evidence Social Security needs and requests, it will have to make a decision based on the information already in your file. A claim decided without your own account of your limits is decided on less than the full picture.

Keep a copy of what you send. If your claim reaches an appeal or a hearing, Social Security considers the statements you made at each earlier step of the process, and this report is one of them. Reading your own words again before a consultative exam or hearing helps you describe your limits the same way twice.

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