How to Fill Out an Adult Function Report / Activities of Daily Living (SSA-3373-BK)

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Elizabeth D’Angelo

You may receive a form called Activities of Daily Living Questionnaire or Adult Function report. Social Security will usually send this form to you about month or two after you first apply for disability. They may also send it during appeals. They also often send it to people who are already on disability during Continuing Disability Reviews.

Social Security may use this form to learn a little more about how your illness limits you and to see if what you write about your limitations is similar to what your doctor writes.

How To Fill Out an 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 many people make. It’s so important that you really admit exactly how bad things are and how much help you really need. It takes a lot of strength and courage to do this.

💮 Be brave. If you feel really shy or embarrassed, please try to find a way to write it anyway. You can feel proud of yourself afterwards for doing something so hard!

💮 It is best to be honest and be consistent. Social Security may look to see that what you have been saying to your doctors is the same thing you are writing on this form.

Before You Start: Try to Take Care of Yourself

💮 If you get a form like this, it’s helpful if you can take time to really think about each question and answer with care, but please try not to become too stressed. Many of our readers report making themselves sick over this form.

💮 Some people become so stressed by this form that their symptoms get worse and they never finish it or send it back. This can cause a denial. It is better to send back something incomplete or imperfect then to send nothing at all.

💮 Some people panic about this form because they think this is their “big chance” to prove they are disabled, and it has to be perfect. It doesn’t really work that way. This is just one form and one of many, many things that will be considered. If what you write here is similar to what your doctor writes in your medical records, then this form may be a small help to your case.

💮 If you need more time, you can call and ask for an extension. It’s best to speak directly to the person listed on the form.

💮 Remember, all the forms they get are from people who are disabled and too sick to work. They aren’t expecting it to be perfect!

Getting Ready

You do not need to do these things. These are things some other readers have found helpful:

💮 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. You will be surprised how long your list is! This list does not need to be sent to Social Security, but can help you when filling out forms and talking to your doctor.

💮 Some people make a blank copy of the form first, in case they want to start again.

💮 Make and keep a copy of the cover page that came with this form. If you have more records in the future to submit, you can use this as a cover page for faxing.

💮 If you want to type instead of write by hand, here is a Fillable Version of Adult Function Report 

Need Help Filling Out Forms? 

If filling out forms is difficult for you:

💮 You can ask a friend to help. If someone else completes the form for you, there is a place at the end of the form where the person who assisted you can write their name and contact information.

💮 Or you can contact the Social Security worker who sent you the form, and request to answer the questions by phone instead. This person’s name and contact information should be included.

💮 Or you can contact your local Social Security office. Let them know you need help and request an appointment with someone who can help you fill out these forms.

💮 In some cases, a lawyer or advocate may also help. However, some lawyers do not assist with function forms.

💮 Do not bring this form to your doctor. If you want your doctor to fill out a form for you, you can bring your doc an RFC form.

💮 Sometimes Social Security will not send you the form, but instead will call and ask you the questions. Some people prefer this, and some don’t. If this happens, you may be able to request to answer in writing, particularly if your disability or disability-related anxiety makes answering questions on the phone difficult for you. Learn more about Phone Calls

How to Describe Your Activities

Here are a few general tips that would apply to all questions on this form:

💮 Most disability lawyers recommend that if you list any activities, it is a good idea to also mention if you have any limitations, any ways anyone assists you, or any way this activity is different for you now than it used to be. Learn more about: How To Describe Your Activities When You Apply for Disability

💮 Try to avoid saying something is “always” or “never” true or that you “can” or “cannot” do something, unless it really is always or never. If it is not always, then you can write “sometimes” “on my bad days….” or “when I am having symptoms…” or “most of the time…”

💮 Include repercussions. For example, “I cannot walk more than x feet without needing to stop and rest.” “I cannot lift more than x pounds without causing pain in my hands and back.”

💮 Be aware of work-like activities. For example, cooking, cleaning and watching children are all things that could be a job. If you list any work-like activities, you can also make a brief note about any limitations with these activities, or anyone who assists you in any way.

💮 Include the impact of side effects. If your med side effects are making it hard to do certain activities, you can mention this. For example: If meds are making you tired, dizzy, in pain, or causing difficulty with focusing and concentrating.

💮 Great advice from attorney Scott Davis: “It is important to assume you are back working full time on a sustained basis (8 hours per day, 5 days per week) when answering questions about what you are capable of doing.”

Five Easy Ways to Answer Any Question

If you get stuck, here’s a few things you can try:

💮 One: Try asking yourself this question: How is this activity different for me now then it was before I got sick? Then write down the answer.

💮 Two: Try asking yourself this question: Does anyone help me in any way, even in a small way, to do this activity? Then write down the answer.

💮 Three: Try asking yourself this question: How much or how long can I do this activity without causing symptoms? Then write down the answer and note what symptoms it causes.

💮 Four: Try asking yourself this question: How often can I do this activity without causing symptoms? Then write down the answer and note what symptoms it causes.

💮 Five: Try writing the magic words. The magic words are: “When I am in pain…” or “When I am having severe symptoms….” or “When my symptoms are bad…” It is also helpful to note how often this happens. How Roselyn Used the Magic Words

💮  If you are still stuck, here’s a list of more questions you can ask yourself about How To Describe Your Activities.

Tricky Questions

Specific questions and ideas from readers on how to approach them:

💮 “How does your illness limit your ability to work?” Write down if there are any medical reasons why you can’t work or why you are limited (for example, if you have problems with lifting, walking, sitting, standing, bending, grasping, focusing, remembering or concentrating). You do not need to include non-medical reasons. More ideas for how to answer the question: “Why Can’t You Work?”.  At the bottom of this page, you can see how Petunia’s Answers The Question “Why Can’t You Work”

💮 “Describe what you do from the moment you wake up to the moment you go to bed” They give you room to write just a few words. Luckily, many of us just lie down all day so there isn’t much to write. Please try not to get too stressed about this question. Just list some things you typically do. Also include if there any ways you are limited or need assistance with those tasks. You can also mention how often or how many hours you lie down, take breaks, etc. At the bottom of this page is how Petunia’s Answers The Question “Describe Your Day”

💮 “Yes or No?” 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.

💮 “Do you take care of children/animals/other people?” If you take care of children, be honest about this. Please don’t forget to include if you need any assistance or if there are any things you are unable to do for your kids, or any limitations you have. Remember: They are not asking if you care about your kids. They are not asking if you are a good parent. They are asking about physical activities you do to take care of your kids. They are asking if you can hold down a job as a babysitter.

💮 “Explain how your illness or injury affects your ability to dress, bathe, care for hair, shave, feed self, and use the toilet.” Good advice from SGB law office:  “Even if you are physically able to do these tasks, you still have problems in these areas if you don’t do them with normal regularity. For example: Dressing: Do you stay in your pajamas during the day? 
Bathing: Do you shower or bathe with the regularity that you had before you got sick. If not, you should note this! Shopping: If you are able to go shopping but typically need someone with you while shopping, be sure to note this.”

💮 Have you ever been fired from a job due to inability to get along with others?They are asking this because inability to get along with others is one of the limitations they consider for people applying for mental illness. If you answer yes to this question, they ask for the employer’s name. If you list an employer here, there is a chance they will contact the employer or send a form to ask questions about your ability to function and take care of yourself. This doesn’t happen often, and some employers chose not to respond.

💮 “How do you handle stress? Changes in routine? Fears? Authority figures?” These questions are all for people applying for mental health. Just answer honestly. If you don’t know the answer, it is OK to write “I don’t know.”

Don’t Be Perfect

💮 Some people try so hard to make everything perfect that they never return the form at all. Please don’t do this. It is better to send back something imperfect than nothing at all.

💮  If they ask something you don’t know, it’s ok to write “N/A” or “I don’t know.” This 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 and send back forms where some questions are blank.

List Three Contact People

💮 The forms may ask you to list the names and contact information for people who can provide information about your life. 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 about this: Do you want your landlord to answer questions about how you brush your teeth?

💮 It is best to 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. See the link at the bottom of this page for more information on third party forms.

“How Much Should I Write?”

There are different opinions by lawyers and advocates about how to fill out this form.

💮  Some people say be very detailed about your limitations, tell them everything with details and examples, and attach extra pages.

💮  Other people say be brief and clear, don’t attach extra pages, and be careful not to write anything that could hurt your case.

You should do what you feel comfortable with.

“Should I Include Attachments?”

💮  If you have any medical tests results or medical records that Social Security does not yet have, you can enclose them with these forms. Sometimes submitting things all together at once increases the chances that nothing gets lost or put in the wrong file. It’s a good idea to also check in with your Disability Examiner about what they already have and what they still need. Some Disability Examiners will only except records that are faxed directly from your doctor’s office.

💮  Some people choose to attach extra pages and some don’t. If you decide to attach something, brief and clear is better than long and rambling. It is not necessary to send long letters telling Social Security your life story and all your struggles. These may not be read, and there are many more important and helpful ways you could be spending your energy to help your application.

💮  Some of our reader’s had success putting together an outline of their medical history and enclosing this.  Here’s a few great examples: How To Make a Medical Outline to Help Your Disability Case.

Working With Your Doctor

💮 Your medical records are the most important part of your disability case. If you want to do something to improve your chances, don’t spend a ton of time on this form, spend a ton of time improving your records!

💮 One of the most helpful things you can do is bring your doc an RFC function form. If what you write on your function form is similar to what your doctor writes on an RFC function form, then both forms put together will be the greatest help!

💮 When Social Security reviews your form, they may look to see that your doctor’s notes say similar things to what you have written on this form. Please always be totally honest with your doctor about all your symptoms and limitations. Everything you do or say in your doctor’s office can appear in your medical records, and may be reviewed by Social Security.

💮 More tips for How to Work with Your Doctor to Get Great Disability Documentation

Get To Know Your Disability Examiner

💮 Your forms should include the name and contact information for your Disability Examiner. This is extremely helpful information! This is the person who collects materials and helps make a decision about your case.

💮 It is (sadly) very common for a disability examiner to never see most of your medical records. Many people get denied for this reason. Luckily, you now know who your disability examiner is so you can make sure that this does not happen to you. How to Stay in Touch with Your Disability Examiner

💮 Sometimes this form is sent to people before a hearing. If you were sent this form while you are waiting for a hearing, then you won’t have a Disability Examiner right now. The form will just get sent to the judge’s office.

Update

💮  Some of our readers are reporting getting this form two or even three times: Once during initial application, and again during reconsideration and/or appeals.

💮 If you get the form again, be sure to include any new symptoms along with any changes to your condition. It’s a good idea to keep a copy of the first form you filled out, so you can remember what you wrote.

Tips from Rose

Rose is a contributor to this site with some super smart ideas for disability applications. Here’s a few of her tips for adult function forms:

💮 Illustrate a picture for SSA to see what your life is like. Think about your worst day. Avoid using the words “always” or “never,” because it can create a problem with credibility. “Typically” and “usually” are good words to use.

💮  Discuss what modifications you use. For example, if the question is, “Do you shower?” The answer might not be “yes” or “no”. The answer might be “Yes, but I use a shower bench and need to lay down for X time to recover afterwards” That answer gives a different picture than just saying “yes”.

💮 If you are unable to complete the packet by the deadline, call the phone number in the packet and request an extension. One extension should be pretty much automatically be granted, but you have to request it. If you just turn in the packet late, then they could make a decision without it and you can get denied for not responding properly.

💮 And make sure you keep a copy of everything you submit!


What’s Next?

💮  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. Make sure to talk directly to the person handling your case (usually called “Disability Examiner“).

💮  Next up, they may send a similar form to your contact person to answer questions about you. Here’s how to handle an Adult Function Third Party Report (SSA-3380-BK)

💮  If this is a new application, Social Security may also send you a Work History Form. How to fill Out a Work History Report (SSA-3639-BK)

💮  If you are already approved and being reviewed, learn more about How to Complete a Continuing Disability Review

💮  If you are still applying, take a look here: How to Greatly, Greatly (Greatly!) Improve Your Disability Application


Updated January 2019. Please comment below with stories, ideas, questions or suggestions. Please let us know if any links on this page stop working. If you found this page helpful, please share it with others by pressing one of these magic little buttons: 

5 thoughts on “How to Fill Out an Adult Function Report / Activities of Daily Living (SSA-3373-BK)”

  1. First of all, I waited 4 years before I got a decision on my disability. It was tough! I was finally awarded full Disability and back pay. i have a multitude of problems. 12 months after my approval I was sent the Continuing Disability Review. (Long Form) I was shocked! I was barely getting over the stress of all the paperwork and waiting when it arrived. It is so stressful and painful to have to fill out all those forms and since I have so many problems and meds it makes those forms that much longer to fill out. I never heard anything back from the review but this week they send me an Adult Function Report to fill out. I just don’t know what to make of it. I am extremely stressed over it that I feel sick. Most everything on there was filled out already on the Continuing Disability Review. It will take me a very long time to get it filled out and will cause so much pain and distress. Also, It said needs to be returned in 10 days. Date of letter is 4-2-19. It’s now 4-15-19 and I just got it a couple of days ago. May have set in mailbox a few days before I got the mail. Why would they want that now and why such a short time to fill out? We are disabled people. Most of us are not able to do things fast….that is why we are disabled. Why put so much stress on us. It just seems repetitive and unnecessary. What do you make of this? Any help would be appreciated. Thanks!

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    1. Many people get reviewed a year after approval. I know it is really stressful, but if there is not change in your condition, most reviews pass without problems.

      If you have not already sent back the form, you can call and request an extension. I hope it goes well for you.

      Like

  2. So I just got my function report (for me and my third party) as part of my (first) SSDI review. I received in my disability in 2016 (and am pretty shocked I had to be reviewed so soon) for Myasthenia Gravis. I absolutely cannot work, and I rely on the Medicare as my insurance. Does the fact that I got these mean that they are questioning my condition and my disability from the longer review form they sent me? Or is this routine for reviews?

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