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How to fill out form SSA-3381

Though not a formal part of the Social Security Disability (SSD) benefits application, the Social Security Administration still requires every applicant to complete Form SSA-3381, which is also known as the Medical and Job Worksheet – Adult.

Why This Form is Important to Your Disability Claim

You must complete this form before you begin your formal application for benefits. It is a “worksheet” and is not submitted to the SSA. The Medical and Job Worksheet is instead designed to serve as your “cheat sheet” for filling out all other forms required throughout the application process.

Form SSA-3381 includes sections that request detailed information on:

  • Your previous employment, including five jobs or the last 15 years of your work history prior to you becoming disabled
  • All your doctors and other healthcare providers, including contact information
  • All medications you take or have taken in the past, including over the counter and prescription drugs

Whether you complete your application online, over the phone, or at your local SSA office, you will need all of the information on this worksheet to fill out every form the SSA requires. This form can also help you keep information straight and ensure that you provide clear and consistent answers to all the SSA’s questions.

Filling Out the Form

Although the SSA advises you not to delay filing your claim, if you are unable to answer all of the questions on the Adult Medical and Job Worksheet, it is important that you try to fill out all sections of the worksheet before you apply for benefits.

  • Spend the time necessary to thoroughly complete every section of the form. You will need to reference this form again and again throughout the application process. You may also need this worksheet if you have to file an appeal and attend a disability hearing. It is therefore crucial that you take the time required to fill out all sections of this form as accurately and completely as possible.
  • Verify the information you list on this form. Some of the details you list on this worksheet may date back several years, like doctors you saw in the past or medical tests you had performed. Take the time to verify the dates of hospital stays, the contact information for doctors and other medical providers, and the names of all the medicines you have taken.
  • Get copies of your medical records. You may need to make a lot of phone calls to verify details for this form. Get copies of your medical records, if possible. This will provide you clear and accurate information for this worksheet, and you can also make copies of your records to send along with your application for benefits.

If you are missing any information, the SSA can try to help you track down those details. It is best though if you have all your information handy when submitting your application, which is exactly the purpose of Form SSA-3381. Consider working with a Social Security attorney or advocate from the start. They can also help you track down required information and assist you in building a strong and detailed case file for SSD benefits.