The Adult Third-Party Function Report, Form SSA-3380-BK, is filled out by describing the claimant’s daily life in concrete, measurable terms based on what you have personally seen. The Social Security Administration sends this questionnaire to someone who knows a disability claimant well enough to describe how their condition affects ordinary activities, and your answers sit in the file next to medical records and the claimant’s own function report. The value of the form comes from specifics: times, distances, weights, frequencies, and examples. Vague sympathy helps no one; honest detail can move a claim.
Who Should Be Answering It
The SSA gives the most weight to observations from people who actually see the claimant living their life. A spouse, adult child, parent, close friend, or neighbor who spends real time with the claimant is the right person. Someone who lives in the household will notice things a monthly visitor never will: how long dressing takes, how often the claimant lies down during the day, whether reminders are needed for medication.
The form asks up front how long you have known the claimant and how much time you spend together. Those questions are not filler. They tell the examiner how much stock to put in the rest of your answers. Twenty years of daily contact carries more weight than a passing acquaintance across the street.
What to Have Ready Before You Start
You need the claimant’s full legal name and Social Security number, plus your own name, phone number, and relationship to them.1Social Security Administration. Function Report – Adult – Third Party The form also asks where the claimant lives and with whom. Living arrangement matters because it changes what the examiner infers from your answers. If the claimant cannot cook and lives alone, that tells one story; if a spouse handles cooking, it tells another.
Before writing anything, think through a recent typical week. What did the claimant do on Monday? Tuesday? What did they not do that they used to do? Having examples in mind keeps your answers from drifting into generalities.
Describing a Typical Day and Personal Care
Section C asks you to walk through the claimant’s day from waking to sleep. Skip “watches TV all day.” The examiner wants a timeline: wake-up time, how long it takes to get out of bed, whether help is needed to get to the bathroom, naps and their length, when meals happen, when the claimant lies down again.
Question 15 covers personal care: dressing, bathing, grooming, feeding, using the toilet. If the claimant uses a shower chair, needs someone to fasten buttons, or has stopped shaving because raising their arms hurts, write that. The form also asks whether reminders are needed for grooming or medication.1Social Security Administration. Function Report – Adult – Third Party Reminders point to whether the claimant can function independently or needs oversight.
Meals, Chores, Getting Around, Shopping, Money
For meals, describe what the claimant prepares now versus what they used to prepare, how often, and what limits them. Someone who once cooked full dinners but now heats frozen meals because they cannot stand at the stove for more than a few minutes is showing real decline; write it that way.
For chores, list what the claimant can still do around the house and yard, how long it takes, and whether they need help or prompting. If folding a small load of laundry is followed by an hour of rest, that detail is more useful than a checkbox.1Social Security Administration. Function Report – Adult – Third Party
For getting around, note how often the claimant goes outside, how they travel, and whether they go alone. If they drive, note any restrictions such as short trips only or no highways because of medication effects. If they cannot travel alone, explain why.
Shopping questions ask what the claimant shops for, how often, and how long it takes. Someone who once did a full grocery run but now manages a handful of items at a convenience store before needing to sit is showing a functional change worth documenting. On money, the form asks about paying bills, using a checkbook, and counting change. If the claimant’s ability to handle finances has slipped, describe the change with an example, such as paying the same bill twice because they forgot.
Physical Limitations, in Numbers
Question 23 lists physical and mental activities the condition may affect: lifting, squatting, bending, standing, reaching, walking, sitting, kneeling, climbing stairs, seeing, remembering, completing tasks, concentrating, understanding, following instructions, using hands, and getting along with others. For every box you check, the form asks you to explain how the limit works in practice.
Numbers are the point here. “She has trouble walking” tells the examiner nothing. “She can walk about half a block before she has to stop and sit down for five to ten minutes” is usable. If the claimant cannot lift more than a few pounds, cannot sit for more than twenty minutes without shifting, or has to rest halfway up a flight of stairs, put those numbers on the page. This detail feeds directly into the residual functional capacity assessment, which decides what work, if any, the claimant can still do.2Social Security Administration. 20 CFR 416.945 – Your Residual Functional Capacity
Memory, Concentration, and Social Functioning
Physical answers are only half of it. The form also asks about memory, concentration, following instructions, handling stress, and adjusting to changes in routine. Examples do the work. “He started to pay the electric bill twice last month because he forgot he had already done it” is the kind of concrete observation an examiner can use. If the claimant cannot follow a recipe they have made for years, or gets confused when plans change, describe the situation.
The real question behind these items is whether the claimant can sustain activity reliably, not whether they can ever do something. Loading a dishwasher on a good afternoon and then spending two days in bed is not the same as consistent function.
Social questions cover how the claimant spends time with others, whether they attend clubs or religious services, and whether their social habits have changed. Withdrawal from activities they used to enjoy is relevant. So is difficulty getting along with family, friends, or people in authority, which speaks to whether the claimant could function around supervisors and coworkers.
Medications and Assistive Devices
Question 25 asks whether the claimant’s medications cause side effects, which ones, and what the effects are.1Social Security Administration. Function Report – Adult – Third Party This is easy to skip past and shouldn’t be. Drowsiness, nausea, dizziness, and mental fog can be as disabling as the underlying condition, and federal regulations list the type, dosage, effectiveness, and side effects of medication as a factor when the SSA evaluates symptoms.3eCFR. 20 CFR 404.1529 – How We Evaluate Symptoms, Including Pain If you have watched the claimant fall asleep mid-conversation after pain medication or seen them too nauseated to eat after chemotherapy, say so.
Question 26 asks about canes, walkers, braces, hearing aids, and other assistive devices. Note what the claimant uses, why, and whether a doctor prescribed it. A cane prescribed after knee surgery carries more weight in the record than one bought at a pharmacy on the claimant’s own initiative, though both belong on the form.
Good Days and Bad Days
Many disabling conditions fluctuate. The claimant might manage a short grocery trip on Monday and be barely able to get out of bed from Tuesday through Thursday. A common mistake is describing only the bad days or only the good ones. Describe both, and describe the pattern: how often the bad days come, what the claimant can and cannot do on each type of day, and whether a burst of activity is followed by a crash.
This matters because the SSA is not asking whether the claimant can ever do anything. It is asking whether they can sustain work-level activity on a regular and continuing basis. Two decent days a week and five terrible ones is the kind of pattern that decides claims, and it will not show up in a fifteen-minute doctor’s visit.
Consistency With the Claimant’s Own Report
The SSA compares your SSA-3380-BK side by side with the claimant’s own function report (Form SSA-3373-BK) and with the medical record. Alignment builds credibility. If the claimant’s doctor has recorded that they can walk two blocks and you write that they cannot get out of bed, the examiner will not average the two; they will start doubting the whole report.
It is fine, and sensible, to talk with the claimant about the form before you fill it out so that you are both describing the same reality. Just answer from your own observations rather than copying theirs. Independent answers that happen to line up with the medical record are far more persuasive than answers that look coordinated.
Mistakes That Sink the Report
Three problems do the most damage.
Inconsistency with the medical record, as above, makes the examiner question everything else you wrote.
Exaggeration is the next. Wanting to help someone you care about is natural, but examiners read these forms professionally and can spot overstatements. Claiming the claimant can do nothing at all, when the medical record shows otherwise, hurts the claim. Minimizing struggles out of respect for the claimant’s dignity does the reverse damage, making the condition look less limiting than it is.
Vagueness is the third. “He has a hard time” is not usable. “He drops things three or four times a day because of numbness in his hands and cannot grip a jar lid” is. Aim every answer at the most specific, measurable description you can give.
Returning the Form
Send the completed form back to the Disability Determination Services office or SSA field office that mailed it to you; a return envelope is usually included. The SSA generally allows about ten days, though this can vary. If you need more time, contact the disability examiner on the case and ask for an extension before the deadline.1Social Security Administration. Function Report – Adult – Third Party Missing the deadline without a word risks the claim being decided without your input.
Once submitted, the form is a permanent part of the claimant’s file. The examiner reads it alongside medical records and the claimant’s own function report, and it stays in the file through any appeal.
A Word on Honesty
The form warns that knowingly providing false information is a federal crime, with potential imprisonment of up to five years under 42 U.S.C. ยง 408.4Office of the Law Revision Counsel. 42 USC 408 – Penalties The SSA can also impose civil penalties for false statements.5GovInfo. 42 USC 1320a-8 – Civil Monetary Penalties and Assessments None of that should make you hesitant to describe real limitations in strong terms. It is only a reminder to describe what you have actually seen, skip guesswork, and resist the urge to embellish. Detailed, honest observation is the most useful thing you can put on this form.