Form SSA-3380, the Function Report – Adult – Third Party, is a questionnaire the Social Security Administration sends to someone who knows a disability applicant personally, asking them to describe how the applicant’s condition affects everyday life. The agency reads it alongside medical records and the applicant’s own function report to decide whether the person qualifies for Social Security Disability Insurance or Supplemental Security Income. A doctor sees a patient for a short visit; a spouse, adult child, neighbor, or caregiver sees whether that person can actually get through a day. That perspective is what this form is for, and getting it right matters, because most initial disability claims are denied and every piece of supporting evidence counts.
Who Should Complete It
The SSA accepts the form from anyone who regularly observes the applicant’s daily routine and can describe specific limitations they have witnessed firsthand. Federal regulations treat this as “evidence from nonmedical sources,” a broad category covering information from someone other than a doctor about any issue in the claim.1eCFR. 20 CFR 404.1513 – Categories of Evidence The form itself asks the reporter to identify their relationship to the applicant and how often they interact.
The strongest reporter is someone who sees the applicant several times a week in ordinary settings. A spouse who watches them struggle to get dressed each morning. An adult child now handling a parent’s grocery shopping. A neighbor who has noticed the lawn stop getting mowed. Paid caregivers and home health aides also qualify, and their observations sometimes carry extra weight because they witness limitations during hands-on tasks like bathing or transferring from bed to wheelchair. Former coworkers or supervisors can be valuable too, especially if they saw the applicant’s stamina or concentration decline on the job.
One hard rule: the form explicitly says not to ask a doctor or hospital to fill it out.2Social Security Administration. Function Report – Adult – Third Party Form SSA-3380-BK Medical professionals provide input through separate clinical forms. The SSA wants a lay observer’s account of real life.
Don’t Copy the Applicant’s Answers
Applicants complete their own version of this questionnaire on Form SSA-3373. The SSA-3380 mirrors it almost question for question, covering personal care, household chores, social activities, and physical and mental abilities. The agency structures the two forms this way on purpose, so examiners can compare them side by side.
The form warns the third party in bold capital letters: “DO NOT ASK THE DISABLED PERSON TO GIVE YOU ANSWERS.”2Social Security Administration. Function Report – Adult – Third Party Form SSA-3380-BK The whole point is an independent perspective. If both reports read identically, examiners may conclude the third party simply copied the applicant. Minor differences in wording are normal and expected. Major contradictions cause problems: if the applicant says they cannot cook at all but the third party describes them making simple meals most days, the examiner has to decide which account is accurate, and that hurts credibility on both sides.
What the Form Asks and How to Answer
The SSA-3380 walks through a typical day from waking up to going to bed, then drills into specific categories of functioning. Every question leaves room for open-ended explanation. Using that space well is where a report either helps the claim or wastes the opportunity.
Daily Routine and Personal Care
The form opens by asking what the applicant does in an ordinary day, then asks specifically about bathing, dressing, grooming, and feeding.2Social Security Administration. Function Report – Adult – Third Party Form SSA-3380-BK If the applicant needs reminders to take medication or can only shower while seated on a bench, put that here. “Yes, they need help” without describing what kind of help or how often misses the point. The examiner reading this wants to picture the applicant’s morning.
Household Tasks and Meals
A separate section covers cooking, cleaning, laundry, and yard work.2Social Security Administration. Function Report – Adult – Third Party Form SSA-3380-BK The most useful answers describe change over time. “Used to cook full dinners every night, now microwaves frozen meals because standing at the stove more than ten minutes causes back spasms” gives a before-and-after picture with a measurable timeframe. “They don’t cook much anymore” does not.
Social Activities
The form asks where the applicant goes regularly, whether they need someone with them, and whether they have trouble getting along with family, friends, neighbors, or authority figures like bosses and landlords.2Social Security Administration. Function Report – Adult – Third Party Form SSA-3380-BK It also asks whether they have ever lost a job because of interpersonal problems. Someone who once attended church every Sunday and hosted weekly dinners but now rarely leaves the house is exactly the kind of decline the examiner is looking to document.
Physical Abilities
The reporter checks boxes for lifting, squatting, bending, reaching, walking, sitting, kneeling, climbing stairs, and using hands, then explains each answer.2Social Security Administration. Function Report – Adult – Third Party Form SSA-3380-BK Specifics matter most here. “She can walk about one block before she has to sit down and rest for five minutes” is far more useful than “she has trouble walking.” Mention any cane, walker, brace, or other assistive device, whether a doctor formally prescribed it or not.
Mental and Cognitive Abilities
The form asks whether the condition affects memory, concentration, completing tasks, understanding, and following written or spoken instructions.2Social Security Administration. Function Report – Adult – Third Party Form SSA-3380-BK Further questions cover attention span, handling stress and routine changes, and any unusual behavior or fears. These matter enormously in claims involving mental health conditions, chronic pain with cognitive side effects, or neurological disorders. Concrete examples work best. “He starts loading the dishwasher but walks away and forgets about it at least three times a week” is stronger than “he has memory problems.”
Handling Money
The form asks whether the applicant can pay bills, keep a savings account, count change, and use a checkbook, and whether that ability has changed. If a spouse has taken over all financial tasks because the applicant loses track of due dates or makes frequent math errors, say so.
Medication Side Effects
A question near the end asks about medication side effects. The form instructs the reporter not to list every medication, only those causing side effects, along with what those side effects are.2Social Security Administration. Function Report – Adult – Third Party Form SSA-3380-BK Drowsiness, dizziness, nausea, and brain fog can limit work capacity as much as the underlying condition. Reporters often skip this section. It is a missed opportunity.
How to Return It, and by When
The form typically arrives by mail with a pre-addressed return envelope. Mailing it back to the Disability Determination Services office handling the claim is the most common method. If a claims examiner provided a fax number, faxing works and gets it into the file faster. Applicants can also submit certain documents electronically through their “my Social Security” account, though not every form type is available for electronic submission.3Social Security Administration. Can I Electronically Submit Documents to Social Security A hired representative can upload the completed form directly through the SSA’s Electronic Records Express portal, categorizing it as “Third Party (Non-medical) Statements.”4Social Security Administration. Electronic Records Express User Guide for Uploading Files Without a Barcode
The SSA generally gives 30 days from the date of its initial request to return disability paperwork. If nothing arrives within the first 15 days, the agency sends a final notice warning that the claim will be denied at the end of the 30-day window. The day after the deadline passes, the SSA can deny the claim outright. The agency is supposed to make “every reasonable effort” to help before doing that, and it won’t penalize someone clearly trying to gather evidence who needs more time.5Social Security Administration. POMS GN 01010.410 – Failure to Submit Essential Evidence Still, the safe move is to return the form well before the deadline, and to call the assigned examiner to request an extension if that isn’t possible.
How Examiners Use the Report
When all the evidence lines up, the decision is straightforward. When it conflicts, the agency follows a specific resolution process: it may recontact a medical provider, request additional records, send the applicant for a consultative examination at SSA expense, or ask for clarification from the applicant or others.6eCFR. 20 CFR 404.1520b – How We Consider Evidence If inconsistencies still cannot be resolved, the agency decides based on whatever evidence it has. A detailed, internally consistent third-party report can tip that balance. When the same functional limitations show up independently in the applicant’s report, the third party’s report, and the medical records, approval gets easier.
Honesty Isn’t Optional
The SSA-3380 is a federal form, and knowingly providing false information on it is a felony. Anyone who makes a false statement of material fact in connection with a Social Security disability claim faces up to five years in prison, a fine, or both.7Office of the Law Revision Counsel. 42 USC 408 – Penalties The same penalties apply to false statements in SSI claims.8Social Security Administration. Social Security Act Section 1632 – Fraud and False Statements For certain professionals involved in the claims process, such as paid representatives or healthcare providers who submit fabricated evidence, the maximum doubles to ten years. Courts can also order restitution, and fraud convictions disqualify a person from serving as a representative payee.
The practical point: exaggerating is not only risky, it backfires. Examiners read hundreds of these reports and can spot descriptions that don’t match the clinical file. An overstated account damages credibility across the entire claim.
Will the Applicant See What You Wrote
Possibly. The form’s privacy notice states that the SSA may share the information with applicants, their authorized representatives, or their representative payees to the extent necessary to pursue the claim.2Social Security Administration. Function Report – Adult – Third Party Form SSA-3380-BK Since the form requires the reporter’s name, address, and phone number, the applicant could see all of it. On the other side, the Privacy Act of 1974 gives applicants the right to request records about themselves from SSA systems, including documents in their disability case file.9Social Security Administration. Submit a Privacy Act Request for Your or Another Persons Records An applicant who wants to see the third-party report can request a copy at their local Social Security office with proper identification. Reviewing it before a hearing is worth doing, so any inconsistencies can be addressed before an administrative law judge raises them.