To write a disability impact statement that helps your Social Security claim, complete Form SSA-3373-BK with specific, honest detail about how your condition changes an ordinary day, describe a typical bad day rather than a good one, and keep every answer consistent with what your medical records already say. The form, officially called the Function Report, is the place where you tell the Social Security Administration in your own words what you can and can’t do since your condition began, and the words you choose carry real weight in the decision.
Why Your Answers Actually Change the Outcome
Medical records show diagnoses and test results. They rarely show whether you can cook dinner without sitting down, walk from the parking lot to a store entrance, or hold your attention through a one-hour meeting. The Function Report fills that gap, and the SSA uses it to build your residual functional capacity assessment, the profile of what you can still physically and mentally do despite your impairment. The adjudicator writing that assessment draws on medical records, doctor opinions, and your Function Report to decide things like how long you can sit, whether you can follow multi-step instructions, and how well you handle workplace stress.1Social Security Administration. POMS DI 24510.006 – Assessing Residual Functional Capacity in Initial Claims
That profile then gets compared to your past jobs, and if you can’t do those, to other jobs the SSA believes you could still perform given your age, education, and work history.2Social Security Administration. Code of Federal Regulations 404.1520 – Evaluation of Disability in General If your medical records show a serious back injury but your form says you can stand for hours and do your own yard work, the adjudicator will likely conclude you can handle more demanding employment than you claim. Downplaying limitations to sound tough or independent works against you.
Write About a Typical Bad Day
Disability determination is about sustained work capacity over a full five-day, eight-hour workweek, not what you managed on your best afternoon. If you can mow the lawn on a good Saturday but spend the next two days in bed recovering, both the activity and the consequences belong on the form. Leave out the recovery and the adjudicator may reasonably conclude you can handle light physical labor five days a week.
Think about what a bad day actually looks like before you sit down with the form. When do you wake up in pain? What do you skip because you can’t manage it? How long does it take to do things that used to be easy? Those are the details the SSA is looking for.
Be Specific Instead of General
The single biggest weakness in most Function Reports is vague answers. “I can’t lift much” tells the adjudicator almost nothing. “I can pick up a gallon of milk but I can’t carry a bag of groceries from the car to the kitchen without resting” gives the examiner a concrete picture to compare against the physical demands of various jobs.
Apply the same specificity throughout. For personal care, there’s a meaningful difference between “no problem” and “I wear slip-on shoes because I can’t bend to tie laces, and I skip showers on bad days because standing in the tub hurts too much.”3Social Security Administration. Function Report – Adult – Form SSA-3373-BK For walking, standing, and sitting, estimate the time or distance before pain or fatigue forces you to stop. For getting around, if you used to drive freely but now only make short trips to the pharmacy, describe that change.
Cover Mental and Cognitive Effects Even If Your Condition Is Physical
Section D asks whether your condition affects memory, concentration, the ability to complete tasks, follow instructions, or handle changes in routine.3Social Security Administration. Function Report – Adult – Form SSA-3373-BK People with primarily physical conditions often rush through this section, but chronic pain makes it hard to concentrate, and heavy medication causes brain fog. If your shoulder injury means you can’t sit at a computer for an eight-hour day without losing focus from the pain, that’s a cognitive limitation worth reporting, even though the underlying problem is physical.
The same section covers social functioning. If you’ve withdrawn from social activities, snap at people because of pain or frustration, or avoid gatherings because of anxiety, describe those changes. The SSA uses that information to evaluate whether you could handle the social demands of a workplace.
Show What Changed
When the form asks about hobbies, social activities, and household tasks, describe what changed and when. “I used to go fishing every weekend but I haven’t been in two years because I can’t sit in a boat that long” is far more useful than writing “fishing” under hobbies. The SSA is measuring the distance between your life before the disability and your life now. Make that gap visible on the page.
Handle Medication Side Effects the Way the Form Asks
Section E asks about medication side effects. The form specifically tells you not to list every medication you take, only the ones that cause side effects.3Social Security Administration. Function Report – Adult – Form SSA-3373-BK For each one, write the medication name and the specific effect. Drowsiness, nausea, dizziness, confusion, and fatigue directly affect work capacity. If a painkiller makes you too drowsy to drive safely, say so, because that limitation eliminates jobs that require operating a vehicle.
Keep It Consistent With Your Medical Records
The examiner will compare your Function Report against your medical records, your doctor’s notes, and any third-party statements in your file. The SSA explicitly evaluates whether your statements about symptoms are consistent with the medical evidence and other records before deciding how much weight they deserve.4Social Security Administration. SSR 16-3p – Evaluation of Symptoms in Disability Claims Inconsistencies give the SSA a reason to discount your reported limitations.
This doesn’t mean you need to copy your doctor’s exact wording. It means your description of daily life should logically fit what your doctors have documented. If your records describe severe lumbar disc disease, an answer saying you can lift 50 pounds and stand all day will not survive scrutiny. If your records describe well-controlled diabetes with occasional neuropathy, claiming you’re bedridden most days will not either. Answer honestly, and honesty tends to line up with the medical file on its own.
Providing false information on SSA forms is a federal crime that can carry fines and up to five years in prison.5Office of the Law Revision Counsel. 42 USC 1383a – Fraud and Related Activity For most applicants, the real risk isn’t fraud but accidental inconsistency or underreporting.
Add a Third-Party Statement for a Second Perspective
The SSA also accepts observations from someone who knows you well through Form SSA-3380-BK, which mirrors the Function Report but is completed by a spouse, family member, friend, or caregiver.6Social Security Administration. Function Report – Adult – Third Party – Form SSA-3380-BK The form says not to have a doctor fill it out, and it tells the third party not to ask you for the answers. The SSA wants their independent observations, not a coordinated story.
A spouse who describes helping you out of bed every morning, or a friend who stopped inviting you to events because you always cancel, can add details you might not think to include yourself. The agency weighs those observations for consistency with everything else in your file.4Social Security Administration. SSR 16-3p – Evaluation of Symptoms in Disability Claims
Don’t Miss the Deadline
The SSA gives you a set number of days to return the Function Report. If you don’t return it, the agency can deny your claim for lack of evidence. Your obligation to provide evidence about your impairment applies at every stage of the process.7eCFR. 20 CFR 404.1512 – Responsibility for Providing Evidence Ignoring the form doesn’t pause your claim; it effectively ends it.
If you can’t meet the deadline because of illness, a family emergency, or delays in gathering records, the SSA can accept a late filing if you show good cause. Recognized circumstances include serious illness that prevented you from contacting the agency, a death in your immediate family, destruction of records by fire or accident, or receiving incorrect information from an SSA representative about the deadline. Physical, mental, educational, and language barriers also qualify.8Social Security Administration. Good Cause for Extending the Time Limit to File an Appeal Contact the SSA as soon as you realize you’ll miss the deadline rather than staying silent.
Submitting the Form and What Comes Next
You can return the Function Report to your local Social Security field office in person or by mail.3Social Security Administration. Function Report – Adult – Form SSA-3373-BK Certified mail with a return receipt gives you proof of the date the agency received it. The SSA also allows online submission through its document upload portal.9Social Security Administration. Submit Forms and Upload Documents Keep a complete copy of your finished form for yourself. If the agency later questions something you wrote, you’ll want to see exactly what you submitted.
Before you send it, read the whole form one more time. Check that your answers about physical limitations match what you wrote about daily activities. Make sure the medication section lists only drugs that cause side effects, as the form instructs. A Function Report that hangs together internally and with your medical records is what the SSA is looking for.
After submission, a disability examiner at your state’s Disability Determination Services office reviews the form alongside your medical evidence.10Social Security Administration. Disability Determination Process The examiner may contact your doctors for more records or schedule you for a consultative examination with an SSA-appointed physician. If you fail to attend that exam without a good reason, the agency can find you not disabled based on the refusal alone.11eCFR. 20 CFR 404.1518 – If You Do Not Appear at a Consultative Examination
If your case eventually reaches a hearing before an administrative law judge, the judge may refer directly to specific answers on your Function Report and ask you to explain them. Anything you wrote months earlier can come back in questioning. That is the practical reason to take the form seriously the first time. If your condition worsens after you submit, you can send an updated Function Report or a written statement describing the changes so the record keeps pace with your situation.