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

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Art: Elizabeth D’Angelo

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The Adult Function Report

If you are applying for disability (or already on disability) at some point, you may receive a form called Activities of Daily Living Questionnaire or Adult Function Report.

This form is usually sent shortly after you first apply. It is sometimes sent during appeals. It is also sent during Continuing Disability Reviews for people already approved.

Social Security uses 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 the 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.

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.

💮 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 “typically” or “usually” or “when I am having symptoms…” or “on most days…”

💮 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 after how long.

💮 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…” and write how often you have bad days. Roselyn Uses 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, write down 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: Answering the question: “Why Can’t You Work?”.  Answers from readers: Sample Answers: 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. Please try not to get too stressed about this question. Just list a few things you typically do, along with any restrictions you have and any ways that that activity is different than how you used to do it before you became disabled. 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 love your kids or 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 work 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

💮 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.

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?”

💮  You don’t have to decide this now. You can always just send back the form now, and then in the next week or two send attachments if you wish. The important thing is to get them the form.

💮  If you have any medical tests results or medical records that Social Security does not yet have, you can enclose them with these forms or send them after. You can also check in with your Disability Examiner about what they already have and what they still need.

💮  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, or may be skimmed very briefly, and there may be more important and helpful ways you could be spending your energy to help your application.

💮  Some of our reader’s had success putting together a brief outline of their medical history.  This could be sent now or after. Here’s a few great examples: How To Make a Medical Outline to Help Your Disability Case.

Great Video by Attorney Jonathan Ginsberg. Watch me.

💮  How Does Social Security Define Sitting, Standing and Walking?

All Done?

💮 If at all possible, make a copy before sending it in.


OTHER HELPFUL THINGS TO KEEP IN MIND

Working With Your Doctor

💮 When Social Security reviews your adult function form, they may look to see that your doctor’s notes say similar things to what you have written on this. It will help a lot if you are always be totally honest with your doctor about all your symptoms and limitations. Some people feel shy or embarrassed and downplay their symptoms, which can cause problems for their disability case: How to Stop Hiding From Your Doctor

💮 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. Now that you know who your examiner is, it may be helpful to get in touch: How to Stay in Touch with Your Disability Examiner

💮 Exception: If you are appealing and getting ready for a hearing, you won’t have a disability examiner, the form will just go to the judge.

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.

💮  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


LEARN MORE

💮  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: 7/1/19

💮 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:

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

  1. So, I am in the appeal process and they mailed me another form that I filled out in the first place. Is this normal? It made me have a panic attack to begin with. Now I have to do it again??? I live in North Carolina does anyone else and do you have any pointers for me? I literally hate that I have to go through this again!

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  2. Hi
    I went through CDR long form & it took a long time. Then I got a letter with this code “SSA-L8052-U2” which I looked up & it means denial but the letter it’s on said I’m still disabled on SSI & will continue Medicaid too. It says I will get reviewed again then it says they do that time to time but doesn’t say when. Most thing worries me is the form numbers are for people denied in CDR but my letter isn’t a denial. Did they print it on the wrong paper or is this normal? I have many serious health problems. I wish I could work but it would be impossible.

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  3. I used your website when I was filling out the daily living paperwork. I was approved after 4 months and in the initial stage. I have stage 4 copd. But the advice you gave on this website helped me so much, I would recommend it to anyone filling out for ssdi…

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  4. Thanks Sleepygirl for all the great info ! My hearing is tomorrow and I’ve been so nervous!! Wish I would’ve found your page before I filled out all of them crazy forms !! You have given so much helpful information.
    Thank you
    Laura

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  5. I was close to 57 when I was approved. Thanks for the info about the coding of the approval letter. I’m going to my docs but am getting tired of it. I’m almost 61. Is there a certain number of physician visits you should make per year to avoid a problem when your review comes up. I hate doctors. I just want my meds refilled. I know they can’t help me and absolutely no more surgeries. What’s your take? Thanks for providing this website wish I would had found it when I was fighting Cigna and Social Security.

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    1. Hi Scott,

      I have not seen any rules specifying a number of required appointments. Generally, they look that you are following doctor’s guidance, so it is considered good to go to the doctor as often as your doctor recommends/writes down.

      Like

  6. Very helpful for me on my 2nd Function Report . I’m going to go over the helpful tips 2 or 3 times . The first thing I won’t forget is honesty.And again Thank you.

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  7. Hello Sleepygirl. First of all, thank you for all your help.
    I have been on disability for 3 years. I got a continuing disability review report (SSA-454-BK) last month, I sent it and now I’m getting a Function Report -Adult form (SSA-3373-BK). Why is that? Should I be worried? This is very stressful.

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  8. 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!

    Like

    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

  9. 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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