Filling out a pain questionnaire for disability means completing SSA Form 3373, the Adult Function Report, and the way to do it well is to replace vague statements about hurting with specific, concrete examples of tasks you can no longer perform, how long you can do them before pain stops you, and what you do to cope. The Social Security Administration uses your answers, alongside your medical records, to build a picture of what you can still do in a workday. Every answer should be honest, detailed, and consistent with the rest of your file.
What SSA Is Actually Scoring
SSA evaluates pain using seven specific factors: your daily activities; the location, duration, frequency, and intensity of your pain; what triggers or worsens it; your medications and their side effects; non-medication treatments you have tried; other measures you use to manage pain such as lying down or using ice; and any other information about how pain restricts what you can do.1Social Security Administration. SSR 16-3p – Evaluation of Symptoms in Disability Claims Nearly every question on the SSA-3373 feeds one of those factors. Once you see the form that way, you stop treating it like a survey and start treating it like testimony.
SSA is also required to consider your own descriptions of your limitations, as well as observations from family, neighbors, and friends.2Social Security Administration. 20 CFR 416.945 – Your Residual Functional Capacity The form is not supplemental. It is evidence.
Gather Your Information Before You Start Writing
SSA gives you a short window to return the form. Pulling records together first prevents the half-remembered answers that weaken claims.
Start with your medical records: doctor’s notes covering diagnoses, treatment plans, and prognoses, plus results from any imaging or testing. Federal regulations define objective medical evidence as findings from “medically acceptable clinical and laboratory diagnostic techniques,” citing examples such as reduced joint motion, muscle spasm, sensory deficit, and motor disruption.3Social Security Administration. 20 CFR 404.1529 – How We Evaluate Symptoms, Including Pain Your answers should line up with what those records show.
Build a complete medication list. Write down every prescription and over-the-counter drug you take for pain or related symptoms, along with dosage, how often you take it, and any side effects. SSA policy requires adjudicators to consider whether medications “create any side effects that cause or contribute to your functional limitations.”4Social Security Administration. POMS DI 25210.040 – The Effects of Treatment Including Medications If a drug makes you drowsy, foggy, or nauseated, that matters.
Then compile a list of every provider who has treated your condition, with contact information and approximate treatment dates. Physical therapy, chiropractic care, pain management, and mental health providers all count. SSA may reach out to them independently, so the list needs to be thorough.
Section by Section
The SSA-3373 is ten pages long. Here is what each part is really asking.
Living Situation and General Information
The opening asks your name, Social Security number, phone number, and whether you live in a house, apartment, group home, or shelter, and whether you live alone or with others.5Social Security Administration. Form SSA-3373-BK – Function Report – Adult These are not throwaway questions. If you live alone, SSA may infer you can handle basic self-care. If that is not accurate, explain elsewhere on the form how you actually manage.
How Your Conditions Limit Your Ability to Work
This looks like a simple prompt but it is one of the most important entries on the form. Do not write “back pain makes it hard to work.” Name the physical and mental demands you can no longer meet: “I cannot sit for more than 20 minutes before pain forces me to stand. I cannot lift more than a few pounds. My pain medication causes drowsiness that makes it unsafe to operate equipment.” Every limitation you name should connect to something a job would require.
Daily Activities
This is the longest section. It asks you to describe a typical day from waking to bed, then digs into caregiving, pet care, personal hygiene, meal preparation, housework, getting around, and shopping.5Social Security Administration. Form SSA-3373-BK – Function Report – Adult Adjudicators read this section as a window into your real functional capacity. If you say you cook full meals daily, do your own laundry, and drive yourself to the store, that reads as someone who can sustain activity, and it will clash with other answers claiming severe limitation.
The form also asks about hobbies, interests, social activities, where you go regularly, whether you need someone with you, and whether you have trouble getting along with people.5Social Security Administration. Form SSA-3373-BK – Function Report – Adult Answer honestly and be specific about changes. “I used to attend church every Sunday but now go once a month because sitting in a pew for an hour causes severe hip pain” tells SSA more than “I don’t go out much anymore.”
How to Describe Your Pain
The function report does not use a numerical scale, but SSA still needs to understand the character, location, and behavior of your pain. Use descriptive language: throbbing, burning, stabbing, aching, radiating. Say where it hurts and where it travels. Explain whether it is constant or comes and goes, and how long episodes last. That covers the second evaluation factor directly: location, duration, frequency, and intensity.6eCFR. 20 CFR 404.1529 – How We Evaluate Symptoms, Including Pain
The most common mistake is writing about pain in the abstract. “I have chronic back pain” gives an adjudicator nothing. Compare that to: “I cannot stand at the kitchen sink for more than ten minutes before radiating pain shoots down my left leg, so I wash a few dishes, sit for fifteen minutes, then wash a few more.” The second version shows a functional limit, shows how pain interrupts a routine task, and reveals the coping strategy you use. One answer, three of SSA’s seven factors.
Do not limit yourself to physical restrictions. Pain often affects concentration, memory, patience, and the ability to follow instructions. SSA has said it will not reject descriptions of how pain affects your ability to “function independently, appropriately, and effectively” simply because objective medical evidence does not fully back them up.7Social Security Administration. 20 CFR 416.929 – How We Evaluate Symptoms, Including Pain If pain makes it hard to read a full page, stay focused during a conversation, or handle minor frustrations without snapping, say so and give a concrete example.
Good Days and Bad Days
Many pain conditions do not produce the same level of suffering every day, and this is where a lot of function reports go wrong. Applicants describe their worst day because that is what feels most relevant to a disability claim. But if SSA later sees evidence that you went grocery shopping last Tuesday, and your form reads like you can barely get out of bed, the inconsistency damages your credibility.
Describe both. Explain what a good day looks like, what a bad day looks like, and roughly how many of each you have per week or month. “On a good day I can walk to the mailbox and heat up a meal. On a bad day I cannot get dressed without help and spend most of the day lying down.” Then explain how quickly and unpredictably the shifts happen. SSR 16-3p directs adjudicators to consider all of the evidence about how symptoms affect your daily pattern of living, so giving them the full range strengthens the claim.1Social Security Administration. SSR 16-3p – Evaluation of Symptoms in Disability Claims
Medications, Treatments, and Self-Help
For each medication, list the name, dosage, how often you take it, whether it actually helps, and every side effect you notice. Side effects matter as much as the pain itself for disability purposes. SSA weighs any limitations that persist even when medication improves your most obvious symptoms.4Social Security Administration. POMS DI 25210.040 – The Effects of Treatment Including Medications If your pain medication controls the worst spikes but leaves you too drowsy to drive or concentrate, write that down. If a drug causes nausea that keeps you from eating regular meals, include it.
For non-medication treatments such as physical therapy, chiropractic care, injections, or surgery, note what you tried, when, for how long, and what happened. If a treatment failed, explain why: “Physical therapy three times per week for eight weeks did not reduce pain levels,” or “Epidural injection provided two weeks of partial relief before symptoms returned.” That history shows a good-faith effort to improve and a condition that has resisted standard care.
Do not skip home remedies and coping strategies. SSA specifically considers “any measures you use or have used to relieve your pain or other symptoms,” including things like lying flat, using a heating pad, elevating your legs, or needing to alternate between sitting and standing throughout the day.3Social Security Administration. 20 CFR 404.1529 – How We Evaluate Symptoms, Including Pain These details reveal limits that medical records alone cannot capture.
Keep a Pain Diary to Prepare
A pain diary will not replace the function report, but it makes filling one out far easier and more accurate. Memory is unreliable, especially when you are in pain daily. A diary gives you a written record instead of guesswork about when your last bad week was or how many days you spent in bed last month.
Each day, jot down your pain level, where it hurt, what triggered it, what you did about it, and how it affected your activities. Note side effects from medications, how long you were able to sit or stand, whether you needed help with anything, and how you slept. Over a few weeks, patterns emerge. Bring the diary to doctor visits and ask your physician to review it and note it in your chart. That turns your personal observations into part of your medical record.
If Someone Else Is Filling Out a Third-Party Report
SSA may also send Form SSA-3380, the Third-Party Function Report, to a family member, friend, or caretaker. It mirrors the SSA-3373 but asks that person to independently describe your limitations. The instructions state the person completing it should not ask you for answers and should not have a doctor complete it.8Social Security Administration. Form SSA-3380-BK – Function Report – Adult – Third Party SSA wants an unfiltered outside perspective.
Choose someone who regularly sees you at home and can describe in detail what you struggle with: a spouse who helps you get dressed, a parent who drives you to appointments because you cannot sit long enough to drive yourself, a friend who has watched your social life shrink. Their observations carry weight, particularly when they line up with what you wrote on your own form.
Review Before Submitting
Before mailing or uploading the form, read every answer with fresh eyes and check three things. Accuracy: do your descriptions match your medical records? If your doctor’s notes say you reported improvement at your last visit, but your form says the pain has been getting worse every month, SSA will notice. Completeness: blank spaces read as “no problem in this area.” If you skipped the meal preparation question because you did not think it mattered, SSA may assume you cook without difficulty. Consistency: do your answers in different sections tell the same story? If you say you cannot stand for more than five minutes in one section but describe doing yard work in another, explain the discrepancy.
Make a copy of the completed form before you submit. You will need it if you are called for a hearing, if SSA requests follow-up, or if the original is lost. Follow the submission instructions on the cover letter, and include any medical releases or authorization forms SSA asked for.
One thing to know about what comes next: if SSA later schedules a consultative examination because it needs more evidence, attend it. Federal regulations allow SSA to find you “not disabled” if you fail to show up without good reason.9Social Security Administration. 20 CFR 404.1518 – If You Do Not Appear at a Consultative Examination If you cannot make the appointment, contact SSA to reschedule.
The function report is one of the few parts of the disability process you control entirely. Medical records are what they are. A consultative examiner will form an independent opinion. The function report is your space to explain, in your own words, how pain has reshaped your life. Take the time to do it thoroughly.