How to Fill Out an Adult Function Report Third Party Form (SSA-3380-BK)

Art: Robin Mead

Third Party Adult Function Report is a form that Social Security sometimes send to your contact person. This form is usually sent out two or three months after you first apply. It is also sometimes used during Continuing Disability Reviews, for people who are already on disability.

They may send your contact person a form, or they may call this person, or they may do nothing and your contact person may never hear from them.

Who Will They Send This Form To?

Social Security will not contact random people. They will only contact the people whose names you gave them.

When you applied for disability, or when you filled out an Adult Function Report, they may have asked you for the name of a person who is familiar with your daily life. This is the person they will contact. If you listed more than one person, they may contact several.

The Adult Function Report also has a space to list any former employers who have witnessed your mental health difficulties on the job. If you listed someone in this space, there is a small chance that person may be contacted. (We have only ever heard from one person whose employer was sent this form).

Who Should I List as My Contact Person?

List people who know your daily life and functioning well and are willing to answer questions about it. Social Security asks for three people, but if you do not have three people who know about your daily functioning, you can list one person and write that there is no one else who knows your condition well.

What Questions Will My Contact Person Be Asked?

Here is a sample: Third Party Adult Function report

What Does Social Security Do With This Form?

The reason Social Security sends out this form is to see what your contact person writes about your daily activities. This form can help them get a better sense of how your disability limits you in daily life.

When Social Security reads this form, one important thing they are looking for consistency. They are looking to see that what your contact person writes is similar to what you write and that is similar to what your doctor writes and to everything else in your file.

In some cases, this form can be a small help to your case, however, at the end of the day, this form is not the most important thing. The most important thing is your medical records.

How to Complete This Form

Social Security does not expect (or want) your contact person to be a doctor or give any kind of medical opinion.

They are simply asking the person to write down anything they have personally seen that might be helpful. It is a good idea to check in with your contact person and talk about this form.

If your contact person does not know your daily life very well, they can simply write “I do not know” for any questions they do not know. For example, your contact person may not be with you in the bathroom when you bathe or brush your hair, so they may not know if you have any problems in that area.

It is always best to tell the truth and it is always better to write “I don’t know” then to guess or make something up.

Including Details About Activities

If your contact person writes down any activities you do, it is helpful if they can also mention if any of these things apply to you:

  1. If they help you in any way with this activity
  2. If they have seen someone else help or assists you with this activity
  3. If they have seen that you have any struggles or limits with this activity
  4. If anything has changed about how much, how often, or how well you perform this activity (compared to before you became disabled)

Will This Form Make a Difference?

Magnolia used to work at Social Security as a Disability Examiner, making disability decisions. Then she became disabled herself. We asked Magnolia if these letters and third party forms make a difference. Here’s what she said: Will Support Letters from Friends or Family Help or Hurt My Disability Application?


Social Security will look to see if your support person has written anything that contradicts what you or your doctor have written. It does not need to be exactly the same, but if there is anything significantly different, they may take note of this. On the other hand, if things are generally similar, this can support your credibility.

For example, if your doctor writes that can’t lift more than five pounds without pain, and then your friend writes you enjoy bowling, this could cause a problem (unless you are using some kind of magical super light bowling ball made of cotton and your friend describes this).

On the other hand, if your doctor writes that you can’t lift more than five pounds without pain, and your friend writes that bowling used to be your favorite hobby, but you had to give it up because of pain, this adds consistency to your file.

Learn more about: How To Describe Your Activities When You Apply for Disability

“My Contact Person Does Not Want to Answer Questions”

This form can be useful, but it is not a requirement. Your contact person is not required to complete the form and they are not required to answer every question. If you contact person does not respond, Social Security will make a decision based on the other records in your file.

If the form does not get returned, Social Security may contact you and ask you to remind your contact person about the form, or ask you for the name of another contact person, but they cannot require another person to answer questions about you.

“My Contact Person Does Not Want to Be Called”

Most of the time these questions are asked on a form, but sometimes an examiner will call and ask the questions over the phone instead.

If your contact person does not want to be called, it may be simplest to just not give out their phone number. List their name and address only. They can also tell the examiner that they don’t wish to answer questions over the phone and request a written form instead.

Learn More

How to Fill Out an Adult Function Report

Applying: How to Greatly Improve Your Application

After Approval: Preparing for Disability Reviews

🌷 This page is part of the free online guide: The Sleepy Girl Guide to Social Security Disability 

🌷 Art on this page by Robin Mead and Elizabeth D’Angelo.

🌷 Page Updated: 8/1/19

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9 thoughts on “How to Fill Out an Adult Function Report Third Party Form (SSA-3380-BK)”

  1. Hi Sleepygirl, do you know if the Contact person that is filling out the form has to be an adult? My son is 17 years old and lives with me, do you think it would be ok for him to complete the form?


  2. About typing the fillable function report – it won’t have barcode/info like pages I was sent. Can I fill in form, and then attach the other part of the packet to include barcode to fax? Can not hand write anymore.


    1. Hi Bonita.

      This is a good question… was the barcode just on the cover page or throughout? If it was just cover page I imagine it would be fine. If it was throughout, I don’t know the answer.

      Either way, if you can keep a copy and contact your disability examiner to make sure it was received, I think that will help. Hope it goes great.


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