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If not complete the following information. NAME I. Can you read and FORM SSA-3368-BK NO J. Can you write more than your name in English 2-2004 EF 2-2004 Use 6-2003 edition Until Supply Exhausted PAGE 1 D. If you cannot remember the names and addresses of any of the doctors or hospitals or the dates of treatment perhaps you can get this information from the telephone book or from medical bills prescriptions and prescription bottles. Disability Rep.

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For adults, the medical conditions that qualify for SSDI or SSI include: Musculoskeletal problems, such as back conditions and other dysfunctions of the joints and bones. Senses and speech issues, such as vision and hearing loss. Respiratory illnesses, such as asthma and cystic fibrosis.

The Adult Disability Report (ADR) is one of several forms you're required to complete when you file an application for Social Security disability benefits. Made up of eleven sections over almost fifteen pages, the ADR asks for detailed information about your education, work history, and medical treatment.

The Adult Function Report examines how your disability affects your day-to-day life. Also referred to as an ADL (activities of daily living) questionnaire, the Adult Function Report is officially known as Function Report SSA-3373.

Social Security Disability Insurance (SSDI) supports individuals who are disabled and have a qualifying work history, either through their own employment or a family member (spouse/parent).

A residual functional capacity (RFC) form can help you with your Social Security Disability claim at both the initial application phase and the appeal hearing level. It is a good idea to have this form completed by your treating physician at the beginning of your claim for Social Security Disability or SSI.

0:08 5:07 Suggested clip How do I fill out the Adult Function Report (Form SSA ... - YouTubeYouTubeStart of suggested clipEnd of suggested clip How do I fill out the Adult Function Report (Form SSA ... - YouTube

You can do this electronically as part of the online Disability application, or you can print, sign, and send the form to your Social Security office.

The law defines disability as the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

The first and most important rule is to always be honest about your activities. Be honest with Social Security, but also be honest with yourself. Many people find it difficult to admit/acknowledge to themselves what their struggles are and how limited they have become.

A Function Report is a multi-page questionnaire about an applicant's activities and how their disabilities impact their daily lives.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232