How to Fill Out an Activities of Daily Living / Adult Function Report


You may receive a form called Activities of Daily Living Questionnaire or Adult Function report.

Different states use different forms.  Here is an example form.

Social Security sends out this form to learn more about your functioning and activities.

Social Security will usually send this form to you about month or two after you first apply for disability. They also sometimes send it to people who are already on disability during medical reviews.

Sometimes they will not send you the form, but instead will call and ask you the questions. If you’d like to be spared this fate, here’s How to Avoid Scary Phone Calls

If you get a form like this, it’s helpful if you can take time to really think about each question, but please don’t stress out about it. It is a common form and often does not have a major impact on your case. Your medical records will be much more important.

How To Fill Out a Great Adult Function Report

  • Be honest with Social Security. It is best to just write what is actually true for you.
  • Be honest with yourself. This is the biggest mistake people make. It’s so important that you really admit exactly how bad things are and how much help you really need. If you cannot do this you will hurt your case and hurt yourself.
  • Be brave. Don’t be shy. Write exactly how bad things are for you. If you feel really shy or embarrassed, please find a way to write it anyway. This is incredibly important.
  • Avoid saying something is “always” or “never” true, unless it really is always or never. Instead you can say “on my bad days….” or “when I am having symptoms…” or “most of the time…”
  • Be aware of work-like activities. For example, cooking, cleaning and watching children are all things that could be a job. If do any work-like activities, think about whether you have any limitations with these activities, or anyone who assists you in any way.
  • It is best to be honest and be consistent. Social Security may look to see that what you are saying to your doctors is the same thing you are writing on this form.


Many times we do not realize all the ways we are limited by our illness. Some people are helped a lot by asking a person they know well or a person who lives with them to review the form and point out any limitations they have seen. Some people also find it helpful to keep a symptom diary for a week, and note any time they are struggling with any activities.


If you list any activities, you may find it helpful to consider the following questions. These questions are just to help you think. You do not need to answer every question or write a long response to each question. A few words or one or two sentences is fine. You can do this for any kind of activity: bathing, brushing your teeth, cooking, reading, etc.

  • Do you have any limitations or struggles with this activity?
  • Is there any ways that this activity is more difficult for you since you became sick?
  • Do you need any help or assistance? Does anyone help you?
  • Does any one help you some of the time or in small ways?
  • Are you are only able to do this for a short amount of time?
  • Do you need to stop and start?
  • Do you do this less often than you used to?
  • Does it take you a long time because you are slow?
  • Do side effects from meds make it harder for you to do this activity? (For example: fatigue, focus, memory, concentration or other side effects)
  • Do you use any medical equipment such as wheelchairs, cane, walkers, or shower chairs when you do this activity?
  • Do you have any mental problems that make this activity harder (focus, memory, concentration)?

I’m Stuck! I Don’t Know What to Write

  • There are a lot of “yes” and “no” boxes. You don’t have to check a box if neither answer is true for you. You can just write “sometimes” or “depends on symptoms” or “see below.” Never write something or check a box that is not true.
  • If you care for children, please don’t forget to include if you need any assistance or or if there are any things you are unable to do for your kids. Remember: They are not asking if you love your kids. They are asking if you can hold down a job as a babysitter.
  • Try your best to answer as much as you can. If you get really stuck its OK to leave some questions blank. A blank answer is better than writing something untrue. Just do the best you can. Many times people with very severe disabilities are unable to complete these forms.
  • Please don’t stress out about the “typical day” question. Just list a few things you struggle with most days, or a few things you often do along with any ways you are limited or need assistance with those tasks.
  • Social Security may look to see that this form to is consistent with the rest of your file. They will be looking to see that what you write is similar to what your doctors are writing. You don’t have to read this right this minute, but when you have a chance: Here’s more about how to Paint a Consistent Picture
  • Once again, you must write honestly about how bad things really are. Some people downplay their condition because they feel shy or embarrassed. This is so important that I am repeating it.

How Much Should I Write?

There are different opinions by lawyers and advocates about how to fill out this form. Some people say be detailed about your condition, tell them all your struggles, and attach extra pages.

Other people say be very brief, never attach extra pages, and be careful not to write anything that could hurt your case.

There is no wrong or right way to do it. My personal opinion is it’s best to be brief and simple. It’s fine to answer questions in just a few words or a few sentences.

How Can I Make it PERFECT?

Some people stress about this form because they think this is their “big chance” to explain themselves and prove they are disabled. It doesn’t really work that way.

This is just a standard form they use to check on your ability function and make sure that what you say about your condition is similar to what your doctor says. No matter what you write, this form won’t “prove” you are disabled. Your medical records are far more important.

Who Should I List As My Contact Person?

Some forms ask you to list the names and contact information for two or three people who can provide information about your life. Some forms don’t have this question. You can list anyone who knows your life well – a friend, family member, or caregiver is often the best person.

They will be contacting this person and asking them some very personal questions about you! Such as what kind of help you need to get dressed, eat, brush your teeth, or take a bath.

The form may offer some friendly suggestions like “You can list your landlord or Social Worker”. Think carefully before doing this: Is your landlord going to be able to answer questions about how you brush your teeth?

It is best to only list someone who truly knows your daily life well and knows your limitations and the kind of care you need. If there is only one person who knows this, then you can just list that one person and write “No one else knows my daily life.” If there is truly no one who can provide information on your life, you can write this, but it is better if you can list at least one person. They may call or write your contact person. If your contact person does not wish to be called, just provide mailing address.

Will They Contact Anyone Else?

I once met someone who had a function form sent to his previous employer from three years ago. I could not figure out how or why Social Security did this. Why would they ask a former employer if you are having trouble washing your hair and brushing your teeth?

This was a big mystery to me until I recently noticed that the Adult Function Form asks you if you have ever been fired from a job due to inability to get along with others, and then asks you the name of the employer. I would guess that if you list an employer here, there is a chance they might be contacted.

For anyone listing a mental health diagnosis, “inability to get along with others” or “inability to get along with supervisors or authority figures” may be considered a symptom of your illness.

What’s Next?

If possible, make a copy of the form before you send it. It may be helpful for you later on.

Whenever sending anything, it’s always a good idea to contact the person handling your case and make sure that it was received and placed in your file.

Next up, they may send a similar form to your contact person to answer questions about you. Learn more about this.

Social Security may also send you a Work History Form. How to fill Out a Work History Report

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s