Form SSA-3380-BK, the third-party function report, asks you to describe how a disability applicant’s conditions affect their everyday life, and to fill it out well you need to write from firsthand observation, use concrete specifics and numbers, and return it promptly to the Disability Determination Services office that sent it. The Social Security Administration uses your answers alongside the applicant’s own report and their medical records to decide the claim, so specific, honest observations do more work than sweeping conclusions about whether the person can hold a job.
Who Should Fill It Out
The SSA wants this form completed by someone who spends real time with the applicant and can describe their limitations from direct observation. A spouse, adult child, parent, close friend, neighbor, or former coworker who sees the person regularly all fit. Two people are explicitly ruled out: the instructions say “Do not ask a doctor or hospital to complete this form,” and in bold letters warn “DO NOT ASK THE DISABLED PERSON TO GIVE YOU ANSWERS.”1Social Security Administration. Function Report – Adult – Third Party Your independent perspective is the point.
Someone who sees the applicant on both good days and bad days is the right choice. A monthly visitor has less to offer than someone who lives with the person or helps them week to week. The form asks how long you’ve known the applicant and how much time you spend together, so examiners will read your answers against that context.
Before You Start
The SSA usually mails the form directly to the person it wants to fill it out, along with a cover letter carrying the contact information for the office handling the claim. You can also download a fillable PDF from ssa.gov or pick up a paper copy at a local field office.1Social Security Administration. Function Report – Adult – Third Party Have the applicant’s full legal name (as it appears on their claim) and Social Security number in front of you so the form gets matched to the right file.
Section A: Your Information and Relationship
Section A collects your identifying details. Question 1 asks for the applicant’s name. You then give your own name, your relationship to the applicant, the date, and a daytime phone number, or a number where the SSA can leave a message if you don’t have a direct line.1Social Security Administration. Function Report – Adult – Third Party
Question 6 asks how long you’ve known the applicant and how much time you spend together, including what you do during that time. Be specific. “I’ve known her for 12 years and visit her home three or four times a week to help with meals and errands” is far more useful than “a long time.” Question 7 asks where the applicant lives (house, apartment, nursing home, shelter, or group home) and whether they live alone, with family, with friends, or in another arrangement.
Section B: How the Condition Limits Work
Section B is one open question: “How does this person’s illnesses, injuries, or conditions limit his/her ability to work?” A common mistake is writing something like “she can’t work because of her back.” Describe the physical or mental limitations you’ve actually seen. For example: “She cannot sit for more than 15 minutes without standing up. She has trouble gripping things with her right hand and drops items regularly. She loses track of conversations and forgets what she was doing mid-task.” Concrete observations do more for a claims examiner than conclusions about employability.
Section C: Daily Activities
This is the longest part of the form and where your detailed observations matter most. It covers the applicant’s daily routine, personal care, sleep, meals, housework, getting around, shopping, money, hobbies, and social life.
Daily Routine, Personal Care, and Sleep
Question 9 asks you to walk through the applicant’s typical day from waking to sleep. Describe what you actually see: how long it takes them to get out of bed, whether they nap, what they spend most of their time doing or not doing. Questions 10 through 12 ask whether the applicant cares for anyone else or for pets, and whether they need help doing so.
Question 13 is one of the most important on the form: “What was the disabled person able to do before his/her illnesses, injuries, or conditions that he/she can’t do now?” This is your chance to draw the before-and-after picture. If the applicant used to coach a kids’ soccer team and now can barely walk to the mailbox, say so. Question 14 asks about sleep disruptions, whether pain wakes them, whether they oversleep, or whether anxiety keeps them awake.
Question 15 covers personal care: dressing, bathing, hair care, shaving, feeding, and using the toilet. Check the “no problem” box where that’s true, but where there are limitations, describe them specifically. “He needs a shower chair and grab bars to bathe safely, and his wife helps him put on socks and shoes because he can’t bend down” gives the examiner something to work with. Question 15 also asks whether the person needs reminders for grooming or medication.1Social Security Administration. Function Report – Adult – Third Party
Meals, Housework, and Getting Around
Question 16 asks whether the applicant prepares meals, what kind, how often, and how long it takes. If they’ve shifted from cooking full meals to microwaving frozen dinners, or skip meals, note the change. Question 17 covers indoor and outdoor chores: which the person can still do, how long they take, and whether they need help or encouragement. If the applicant used to mow the lawn weekly and now can’t push a mower at all, that contrast matters.
Question 18 asks how often the person goes outside, how they travel (walk, drive, ride, public transit, bicycle), and whether they can go out alone. Question 19 covers shopping: in stores, by phone, online, or by mail, and how long a trip takes. If they used to grocery shop independently and now rely entirely on someone else or on delivery, describe that shift.
Money, Hobbies, and Social Life
Question 20 asks whether the applicant can pay bills, handle a savings account, count change, and use a checkbook or money orders. If cognitive decline has made it impossible to manage finances (missed bill payments, math errors, untracked spending), describe examples you’ve witnessed.1Social Security Administration. Function Report – Adult – Third Party
Question 21 asks about hobbies and interests, how often and how well the person does them, and any changes since the condition began. Question 22 covers social activities: how the person spends time with others, where they go regularly (church, community groups, sports events), whether they need reminders or someone with them, and whether they have trouble getting along with family, friends, or neighbors. Withdrawal from activities they once enjoyed is exactly the pattern examiners look for.
Section D: Physical and Mental Abilities
Section D is a structured assessment. Question 23a lists areas the condition may affect:
- Physical: lifting, squatting, bending, standing, reaching, walking, sitting, kneeling, stair climbing, and using hands
- Sensory: talking, hearing, and seeing
- Cognitive: memory, completing tasks, concentration, understanding, and following instructions
- Social: getting along with others
Check every box that applies and use the follow-up questions to fill in the specifics. Question 23c asks how far the person can walk before needing to stop and rest; give a distance like “about half a block” or “from the front door to the car.” Question 23d asks how long they can pay attention. Question 23e asks whether they finish what they start. Questions 23f and 23g ask how well they follow written and spoken instructions. If instructions have to be repeated several times or the person can’t follow a simple recipe, say so.1Social Security Administration. Function Report – Adult – Third Party
The rest of Section D asks how well the person gets along with authority figures, whether they’ve been fired for interpersonal problems, how they handle stress and changes in routine, and whether you’ve noticed unusual behavior or fears. For mental health conditions these carry significant weight, because the SSA evaluates mental functioning across understanding and applying information, interacting with others, concentration and persistence, and adapting or managing oneself.2Social Security Administration. Mental Disorders – Adult
Medications, Assistive Devices, and Remarks
Question 24 asks whether the applicant uses assistive devices: crutches, a cane, walker, hearing aid, brace or splint, glasses, wheelchair, artificial limb, or artificial voice box. Question 25 asks about medications, but specifically only those that cause side effects. Don’t list every prescription. Name the medicine and describe the side effects the person experiences.1Social Security Administration. Function Report – Adult – Third Party If a pain medication causes severe drowsiness or nausea that limits what the person can do during the day, that matters.
Section E is space for additional remarks. Use it if you ran out of room earlier or want to add context the questions didn’t capture.
Writing Answers an Examiner Can Actually Use
The most common problem with this form is vagueness. “He has trouble with daily tasks” tells an examiner nothing. “He cannot stand at the stove for more than five minutes, so he eats cold sandwiches or cereal for most meals” tells them exactly what they need to know. A few principles carry most of the weight:
- Describe worst-day observations, not just good days. If the applicant can do something once but pays for it with two days of pain or exhaustion afterward, say that.
- Use numbers wherever possible. “Can walk about 50 feet before needing to sit.” “Takes 45 minutes to get dressed.” “Forgets appointments at least twice a week.” Numbers give examiners something concrete.
- Focus on changes over time. What the person used to do easily and now can’t, or can only do with help, shows functional decline better than any adjective.
- Write “I don’t know” when you genuinely don’t know. Guessing undermines the credibility of the answers you’re sure about.
- Don’t exaggerate, and don’t downplay. Overstating limitations backfires if the examiner spots inconsistencies with medical records. Understating them, sometimes out of not wanting the person to seem helpless, hurts the claim just as much.
The SSA compares your report against the applicant’s own function report (Form SSA-3373-BK) and their medical records. The agency wants consistency across sources, not identical answers. Your report is valuable because it comes from a different vantage point, which is why the instructions prohibit coordinating your answers with the applicant.1Social Security Administration. Function Report – Adult – Third Party
How to Submit It
Return the completed form to the office that sent it. The cover letter carries the address and phone number of the handling office, usually the state’s Disability Determination Services (DDS). If you’ve lost the letter, call the SSA at 1-800-772-1213 (TTY 1-800-325-0778) to get the right address.1Social Security Administration. Function Report – Adult – Third Party You can also drop the form off at a local field office.
Many SSA documents can be submitted online through the “Upload Documents” feature on ssa.gov, and forms can also be faxed or mailed.3Social Security Administration. Social Security Forms If you mail it, use a service with tracking. If you hand-deliver it, ask for a date-stamped copy. Keep your own copy either way. An examiner may call with follow-up questions, and you’ll want to see what you originally wrote.
The form does not set a hard deadline for return, but it warns that “failing to provide all or part of the information may prevent an accurate and timely decision on any disability claim filed.”1Social Security Administration. Function Report – Adult – Third Party In practice, DDS will move forward with the evidence it has. Return the form quickly. A claim can be decided without your input if you wait.
What Happens After You Send It In
Your report joins the disability case file alongside the applicant’s own function report, medical records, and other evidence. A disability examiner reads all of it together. Consistency is what they’re checking for. If you describe the applicant as unable to stand for more than ten minutes but their own report says they cook full meals every night, that discrepancy gets scrutiny.
Your observations can corroborate what the medical records show and fill in gaps that medical appointments miss. A doctor sees the applicant for 15 minutes. You see them struggle through the other 23 hours and 45 minutes. The information you provide becomes a permanent part of the file and is used in later reviews, including appeals and continuing disability reviews.
Accuracy and Legal Consequences
The information you provide will be used to decide the claim. Federal law makes it a crime to knowingly provide false information on a government form; penalties can include a fine and up to five years in prison.4Office of the Law Revision Counsel. 18 U.S. Code 1001 – Statements or Entries Generally The burden of proving disability rests on the applicant, who must submit all relevant evidence.5Social Security Administration. 20 CFR 404-1512 – Responsibility for Evidence Honest observations, even when they show the applicant can still do some things, carry more weight than an exaggerated account an examiner may discount entirely.