How to Fill Out and Submit the Adult Function Report (SSA-3373-BK)

The SSA-3373-BK Function Report is a ten-page questionnaire the Social Security Administration sends after you file for Social Security Disability Insurance or Supplemental Security Income, asking you to describe in your own words how your conditions affect everyday tasks like dressing, cooking, shopping, handling money, and getting along with other people. Your answers go to a Disability Determination Services examiner who reads them alongside your medical records to judge what you can still do despite your impairments, so the way to help your claim is to answer every question with concrete, specific detail that lines up with what your doctors have documented.¹

When It Arrives and How Long You Have

The form usually arrives by mail from your state DDS office after you file your initial application. A cover letter names the examiner assigned to your case and typically asks you to return the completed form within ten days. You can also download a blank copy at ssa.gov/forms or pick one up at your local field office.¹

If ten days is not enough, call the examiner listed on the letter and ask for more time. Extensions are generally granted when you communicate. What you cannot do is ignore the form or send it back half-finished. The form itself warns that “failing to provide all or part of the information may prevent an accurate and timely decision on any claim filed.”¹ Incomplete answers force the examiner to guess, and guesses rarely favor the claimant.

Set aside several hours, and split the work across more than one sitting if you need to. Rushing produces the kind of vague answers that weaken claims.

Sections A and B: Who You Are and What Limits You

Section A collects your name, Social Security number, daytime phone number, the type of housing you live in, and who lives with you. Get every detail right; small errors slow processing.¹

Section B has one open question that carries real weight: “How do your illnesses, injuries, or conditions limit your ability to work?” A single line like “I can’t work because of my back” wastes the space. Name the specific work tasks your conditions prevent. If standing more than fifteen minutes causes shooting pain down your leg, write that. If your medication leaves you too drowsy to concentrate through a shift, write that too. This answer shapes what the examiner focuses on when reading everything that follows.

Section C: Your Daily Activities

Section C runs from question 6 through question 19 and walks through a full day. The point is not to prove you are helpless. It is to show, honestly and in detail, how your conditions have changed what you can do.

Your Daily Routine and Caregiving

Question 6 asks you to describe what you do from waking up until going to bed. Write it as a narrative. If you wake stiff and need thirty minutes of stretching before you can get out of bed, include that. If you spend most of the afternoon lying down because of fatigue, include that. Do not gloss over parts that feel embarrassing or trivial; the pattern of your day is what the examiner is reading for.

Questions 7 through 9 ask about caregiving for a spouse, children, grandchildren, parents, or pets. If someone now helps with duties you used to handle alone, name that person and explain why the help is needed. A claimant who used to walk the dog three times a day but now only manages a short trip to the backyard because of knee pain should say exactly that.¹

Question 10 asks what you were able to do before your conditions started that you can no longer do. Be concrete. “I used to coach my son’s baseball team and now I can’t throw a ball or stand on the field for an hour” tells the examiner more than “I can’t do sports anymore.”

Personal Care, Meals, and Housework

Question 12 asks whether your conditions affect dressing, bathing, hair care, shaving, feeding yourself, or using the toilet. For every item you check, explain what actually happens. “I need my wife to button my shirts because I can’t grip small objects” ties your self-report to a medical finding about hand dexterity. Time estimates help: a shower that used to take ten minutes and now takes forty because you have to sit on a bench and rest is worth saying so.

Question 13 covers meal preparation and whether you need reminders for grooming or medication. If you can only microwave pre-made food because standing at the stove triggers back spasms, describe both the limitation and the workaround. Question 14 covers housework and yard work: what you still do, how long it takes, whether you need help. If vacuuming the whole house used to be one session and is now one room followed by an hour of rest, that is exactly the kind of detail the question is asking for.

Getting Around, Shopping, and Money

Question 15 asks whether you drive and whether you can go out alone. If seizures, vision problems, or medication side effects ended your driving, explain that. If you rely on someone else for rides, note it. Question 16 covers shopping: how often, how long, and whether in person or online. Switching to grocery delivery because you can no longer walk through a store is relevant evidence.

Question 17 asks yes-or-no whether you can pay bills, count change, handle a savings account, and use a checkbook or money orders, then asks you to explain any “no” answers and note any change since your conditions began.¹ If you used to manage the household finances and now make frequent errors or have handed bill-paying to a family member, say so.

Hobbies and Social Activities

Questions 18 and 19 ask about hobbies and time spent with other people. The examiner is not judging your social life; the questions measure changes in functioning. If you used to attend church twice a week and now go once a month because crowds trigger anxiety, that is a decline. If you gave up woodworking because you can no longer grip tools, that ties to a physical limitation. Say what you still do, and explain what changed.

Section D: Abilities, Assistive Devices, and Medications

Section D is the most structured part of the form. Question 20a lists nineteen items your conditions may affect:

Physical: lifting, squatting, bending, standing, reaching, walking, sitting, kneeling, stair climbing, using hands
Sensory: talking, hearing, seeing
Cognitive and social: memory, completing tasks, concentration, understanding, following instructions, getting along with others

Check every item that applies and explain each one. The form prompts you for measurable detail, such as how many pounds you can lift or how far you can walk before needing to stop.¹ “I can lift about five pounds but anything heavier causes a flare-up that lasts two days” gives the examiner something to work with. “I have trouble lifting” does not.

The rest of Section D asks how long you can pay attention, whether you finish what you start, how well you follow written and spoken instructions, how you handle authority figures, whether you have ever been fired for interpersonal problems, how you cope with stress and changes in routine, and whether you have noticed unusual behaviors or fears. These address the mental demands of work as directly as the checklist addresses the physical demands. If your concentration gives out after ten minutes, or if unexpected changes trigger panic attacks, describe what actually happens.

Question 21 asks about assistive devices: crutches, a cane, walker, wheelchair, brace or splint, hearing aid, glasses, artificial limb, or artificial voice box. Note whether a doctor prescribed the device and whether you use it daily or occasionally.

Question 22 asks about medication side effects. You do not have to list every medication, only the ones that cause side effects, with the medication name and the specific effect. Drowsiness, dizziness, nausea, confusion, and weight gain directly affect work capacity. This question is easy to skim past, but side effects can limit a full workday on their own, even when the underlying condition is partly controlled by treatment.¹

Section E: Remarks

Section E is an open space for anything the smaller answer boxes cut short. Use it. If your condition fluctuates between good days and bad days, describe the pattern here, including roughly how many bad days you have per month and what a bad day looks like. The instructions say to reference the original question number for any continued answers so the examiner can match them up.¹

Mistakes That Weaken a Claim

The most damaging mistake is inconsistency between what you write on the function report and what your medical records show. If your doctor’s notes say you reported moderate pain at your last visit but your form describes being bedridden, the examiner will notice. That is not a reason to downplay symptoms. It is a reason to make sure your self-report and your treatment history tell the same story. If your symptoms have worsened since your last visit, say so on the form and book a follow-up appointment so your records catch up.

Other errors that hurt claims:

Leaving blanks. The form says to never leave an answer blank; if a question does not apply, write “does not apply” or “none.” A blank reads as skipping.¹
Vague one-line answers. “I have trouble cooking” tells the examiner nothing. “I can only heat up canned soup because standing at the stove for more than five minutes makes my lower back seize up” tells them what you can and cannot do.
Reporting only your worst days or only your best days. Describe both, so the picture is accurate.
Covering only physical or only mental limitations. Chronic pain often disrupts concentration and sleep. Depression often causes fatigue and slowed movement. Cover every area the condition touches.

The Third-Party Function Report

Someone close to you may also receive Form SSA-3380-BK, the Function Report – Adult – Third Party. A spouse, family member, friend, or caretaker fills it out from their perspective. The form tells the third party not to ask you for answers and not to have a doctor or hospital complete it.² The examiner compares both reports for consistency, so a third-party report that lines up with yours strengthens your claim. Choose someone who sees you regularly and understands how your conditions affect your day.

Submitting the Form

Mail or bring the completed form to your local Social Security office. The form directs you to socialsecurity.gov to find the nearest office, or you can call 1-800-772-1213 (TTY 1-800-325-0778). If your form came directly from a DDS examiner with a return address, send it to that office instead.¹ Photocopy every page before you send it. You may need to reference your own answers later, especially if you have to appeal.

After the examiner reviews your form against your medical records, the agency may contact you to clarify answers or request more records. If the file still does not give the examiner enough to decide, the SSA may schedule a consultative examination at its expense. Attend it if you are scheduled; not showing up without a good reason can lead to a finding that you are not disabled.³

1
Social Security Administration. Form SSA-3373-BK Function Report – Adult
2
Social Security Administration. Function Report – Adult – Third Party Form SSA-3380-BK
3
eCFR. 20 CFR 404.1518 – If You Do Not Appear at a Consultative Examination