Form SSA-3368 Adult Disability Report: Sections, SSA-827, and Filing

To fill out Form SSA-3368, the Adult Disability Report, work through its nine sections using plain, specific language about how your conditions limit you, and gather your medical providers, medications, and five-year work history before you start so you’re not guessing at details mid-form.¹ Roughly two-thirds of initial disability claims are denied, and incomplete or inconsistent answers are a common reason.²

Gather Your Records First

Stopping mid-form to hunt for a fax number or a medication dosage is how mistakes get in. Before you open the form, pull together:

Two contact people who know about your medical situation and can help the agency reach you. They cannot be your doctors, and the form does not ask for their Social Security numbers.¹
Full name, mailing address, phone, and fax for every doctor, therapist, hospital, and clinic that has treated you, with the dates seen and any specific tests such as MRIs, blood panels, or psychological evaluations.
Every prescription and over-the-counter medication you currently take, the dosage, and which doctor prescribed it.
Your job titles, employers, dates, and the physical demands of each job for the past five years, including how much weight you lifted and how much time you spent standing, walking, or sitting.
The highest grade you completed and any specialized vocational training or certifications.

One caution about the work history: older guides and older versions of the form reference a 15-year window. Under Social Security Ruling 24-2p, effective June 2024, the agency now looks only at work you performed in the five years before your disability began, and any job that started and stopped in fewer than 30 calendar days does not count.³ If your recent work was physically demanding, the agency can no longer point to a desk job from a decade ago as evidence you can still work.

Working Through the Nine Sections

Sections 1 and 2: You and Your Contacts

Section 1 is basic identifying information. Section 2 asks for two people who can speak to your day-to-day limitations. Pick people who have actually watched your condition affect your life, such as a spouse, adult child, or close friend. The examiner may call them, so give them a heads-up.

Section 3: Your Medical Conditions

This is the most consequential section. List every physical and mental condition that limits your ability to work, each one separately, and use your own words rather than medical jargon.⁴ Instead of writing “lumbar radiculopathy,” write “severe lower back pain that shoots down my left leg and makes it impossible to stand for more than ten minutes.” The examiner cross-references your descriptions against your medical records, and specific language about functional limits carries more weight than clinical terminology.

The agency compares your conditions against its Listing of Impairments, sometimes called the Blue Book.⁵ You don’t need to know the listing numbers. Describe everything thoroughly and let the medical consultant do the matching.

Section 4: Current Work Activity

Section 4 asks whether you’re working now, when you stopped, and whether your condition forced changes like fewer hours or different duties. This information helps the examiner determine whether your earnings fall below the substantial gainful activity threshold, which for 2026 is $1,690 per month for most applicants and $2,830 per month for applicants who are blind.

If you tried to return to work and could not sustain it, put that here. Social Security calls this an “unsuccessful work attempt,” and it helps rather than hurts your claim. To qualify, the work must have lasted six months or fewer and ended, or dropped below the substantial gainful activity level, because of your impairment. Describe what the job was, when you started, what went wrong, and why you had to stop. Also note any special conditions that made the job briefly possible, like extra help from coworkers, frequent rest breaks, reduced productivity expectations, or a family member who drove you. Those details show the examiner the work wasn’t sustainable without accommodations a normal employer wouldn’t provide.⁶

Section 5: Education and Training

Record your highest grade completed and any specialized training. The agency uses this to judge whether you could transition to less demanding work. If your background is limited to a physically demanding trade, that actually strengthens your claim, because it narrows the alternative jobs the agency can suggest.

Section 6: Work History

List every job you held during the five years before your conditions stopped you from working.³ For each job, give the title, employer, dates, and a specific description of the physical and mental demands. How much weight did you lift? How many hours were you on your feet? Did the job require reaching overhead, crouching, or operating machinery? The examiner compares those demands against what you can still do. Applicants often rush this section, and it drives the outcome when a claim doesn’t get approved on medical grounds alone.

Sections 7 and 8: Medications and Providers

Section 7 asks for every medication you take, why you take it, and who prescribed it. Section 8 asks for every provider that has treated you, with complete addresses and dates. These sections create the roadmap the examiner follows when requesting your records. Leave out a provider or a prescription and the agency works from an incomplete picture. Check that the medications you list match your pharmacy records, because discrepancies raise credibility questions.

Section 9: Other Records Holders

Section 9 asks whether anyone besides your healthcare providers holds medical records about you, such as a workers’ compensation insurer, the Department of Veterans Affairs, or a vocational rehabilitation agency. List them so the examiner can request those records too.

How to Describe Mental Health and Cognitive Symptoms

The form doesn’t have a separate mental health section, but Section 3 explicitly covers emotional and cognitive conditions alongside physical ones.⁴ Applicants with depression, anxiety, PTSD, or cognitive impairments often understate these symptoms because they focus on physical problems. If you have trouble concentrating, forget instructions, can’t handle stress, struggle to leave the house, or have panic attacks in public, describe each limitation concretely. “I can’t follow a conversation for more than a few minutes” tells the examiner more than “I have difficulty concentrating.”

After the SSA-3368, the agency often sends a Function Report (Form SSA-3373) asking detailed questions about daily activities: cooking, bathing, socializing, managing money, getting around.⁷ Your answers on the two forms need to be consistent. If you tell the 3368 you can’t stand for more than ten minutes, don’t describe hour-long grocery trips on the 3373.

Sign SSA-827 So the Agency Can Get Your Records

The SSA-3368 tells Social Security where your records are. Form SSA-827 gives it permission to go get them. You’ll sign the authorization alongside or shortly after submitting your disability report. Without a signed SSA-827, the state Disability Determination Services office can’t request a single page of your file, and Social Security sends more than 14 million record requests each year.⁸

The authorization is valid for 12 months from the date you sign it and covers all your providers, so you don’t need a separate form for each doctor or hospital. It can include substance abuse treatment records if applicable.⁸ If your claim takes longer than a year, the agency may ask you to sign a new one.

How to Submit the Form

You can complete the SSA-3368 through the Social Security website. The online version lets you save your progress and return later using an eight-digit re-entry number. If you lose it, retrieve it by signing in to your my Social Security account.⁹ Save the confirmation number you receive after submission. That is your proof the agency received the form.

If you prefer paper, print the form from ssa.gov and mail it to the field office that handles your area. Use certified mail with a return receipt so you have proof of the date received. You can also hand it in at a field office during business hours. Ask for a stamped copy or a written receipt. Your filing date affects when benefits begin if you’re approved, so protect it.

Accuracy and the Legal Line

Everything on this form is subject to federal law. Knowingly providing false information can result in a fine, up to five years in prison, or both.¹⁰ That doesn’t mean you need perfect recall of a treatment date from three years ago. It means don’t invent conditions, fabricate medical visits, or misstate your work history. If you’re unsure of a date, give your best estimate and say so.

Once you submit, the file goes to your state’s Disability Determination Services office, where an examiner and a medical or psychological consultant review your form and request records from every provider you listed in Section 8.⁴ If the records aren’t enough to decide, the agency may schedule a consultative examination with an independent doctor at no cost to you. Go to that appointment. Skipping it without good cause forces a decision on whatever is already in the file, which rarely leads to an approval. The initial decision generally takes six to eight months.¹¹

1
Social Security Administration. SSA-3368-BK – Disability Report – Adult
2
Social Security Administration. Annual Statistical Report on the Social Security Disability Insurance Program
3
Federal Register. Social Security Ruling, SSR 24-2p – Titles II and XVI: How We Evaluate Past Relevant Work
4
Social Security Administration. POMS DI 11005.023 – Completing the SSA-3368-BK (Disability Report – Adult)
5
Social Security Administration. Disability Evaluation Under Social Security – Listing of Impairments
6
Social Security Administration. POMS DI 11010.145 – Unsuccessful Work Attempt (UWA) Overview
7
Social Security Administration. Function Report – Adult – Form SSA-3373-BK
8
Social Security Administration. Information on Form SSA-827
9
Social Security Administration. Return to a Saved Application
10
Office of the Law Revision Counsel. 18 USC 1001 – Statements or Entries Generally
11
Social Security Administration. How Long Does It Take to Get a Decision After I Apply for Disability Benefits?