Filling Out Form SSA-3373

How to Fill Out Form SSA-3373—Function Report (Activities of Daily Living)

Most applicants do not precisely meet a listed disability with the Social Security Administration (SSA). If your medical condition does not meet a listing, then the SSA will need more information from you, including how your disability affects your everyday life. That is the purpose of Form SSA-3373, which is also known as the Adult Functional Report.

Why This Form is Important to Your Disability Claim

If you receive a Functional Report form from the SSA, you must complete and return it by the deadline defined. The form asks for information on your everyday “activities of daily living,” including:

  • Where and with whom you live
  • If you care for other people or pets
  • If you need help from others in completing activities
  • Information on how you shop, complete household tasks, prepare meals, and care for yourself
  • Whether or not you drive or how you get around
  • Details of your personal life, including your hobbies and social life

All of this information helps the SSA assess how your symptoms and limitations affect your ability to complete everyday tasks. This in turn allows the SSA to analyze how your symptoms and limitations affect your ability to complete typical job functions. Form SSA-3373 provides crucial information about your medical condition and whether or not it qualifies you for Social Security Disability (SSD) benefits.

Filling Out the Form

The information you provide on your Functional Report is combined with other information in your claim to decide whether the SSA grants you benefits.

  • Take the time to understand and fully complete the form. Some of the information the SSA asks for on the Functional Report is a repeat of details you have already submitted on other forms. The form is also long and asks for many details. Invest the time necessary to fill out all parts.
  • Respond by the defined deadline. If you fail to complete and return this form by the set deadline, your claim will be dismissed. Keep your disability application active by meeting the SSA’s deadline.
  • Be honest in your responses. You must provide an accurate and honest assessment of your activities of daily living on this form. Keep in mind too that the SSA typically requests information about your medical condition from multiple sources, and not just from you or your doctor.
  • Leave no blanks on the form. Every question on the Functional Report requires an answer, even if the response you give is “not applicable,” “does not apply,” or “I don’t know.” Any blanks lead the SSA to more questions. Blanks can delay your claim and can also lead to a denial of benefits.

The information you provide on Form SSA-3373 is very important in deciding your eligibility for SSD benefits. You may wish to consider getting help with this form and in dealing with all other inquiries from the SSA. A friend, family member, disability attorney, or advocate can help.

Additional Resources

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