If you’re applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits, you understand how overwhelming the process can feel. Form SSA-3368, officially called the “Disability Report – Adult,” is one of the most critical documents in your disability claim, yet it’s also one of the most complex forms you’ll encounter.
This comprehensive form asks detailed questions about your medical conditions, work history, daily activities, and how your disabilities affect your ability to function. The information you provide directly influences whether the Social Security Administration (SSA) approves or denies your claim. Every section matters, and incomplete or unclear responses can delay your application or lead to an unfavorable decision.
We will walk you through each section of Form SSA-3368, providing step-by-step instructions that help you understand what information is needed and how to present it effectively. You’ll learn what documentation to gather, common mistakes to avoid, and strategies for clearly communicating how your disabilities impact your daily life. Our goal is to help you complete this form thoroughly and accurately, giving your disability claim the best possible chance of approval.
What You Need to Know Before Starting
Form SSA-3368 is typically the longest and most detailed form in your disability application package. The SSA uses this information to understand the full scope of your medical conditions and their impact on your ability to work. Unlike shorter forms that focus on basic demographics, this disability report requires you to think comprehensively about your health, work history, and daily functioning.
Key Information This Form Collects:
- Detailed descriptions of all your medical conditions
- Complete work history for the past 15 years
- Information about all healthcare providers who have treated you
- Medications you currently take and their side effects
- Daily activities and how your conditions limit them
- Educational background and special training
The form contains approximately 20 sections with dozens of individual questions. Some sections may not apply to your situation, but you should review each one carefully. The SSA designed this form to capture information that disability examiners and medical consultants need to evaluate your claim under Social Security’s disability determination process.
Time Investment Required: Plan to spend 4-6 hours completing Form SSA-3368 thoroughly. This isn’t a form you can rush through in one sitting. You’ll need time to gather medical records, recall specific dates, and thoughtfully describe how your conditions affect your daily life. Many successful applicants spread the completion over several days, allowing time to review and refine their responses.
Before You Begin Gathering Information: Create a dedicated workspace where you can organize documents and work without interruption. You’ll be referencing multiple sources of information and may need to contact healthcare providers or former employers for specific details. Having a systematic approach from the start will save you time and reduce stress.
Required Documentation and Information Gathering
Successfully completing Form SSA-3368 requires extensive preparation. The more organized you are before you start filling out the form, the more accurate and complete your responses will be. This preparation phase is crucial because incomplete information often leads to requests for additional evidence, delaying your claim processing.
Medical Information You’ll Need: Compile a comprehensive list of all healthcare providers you’ve seen in the past year, including their full names, addresses, phone numbers, and patient identification numbers. This includes primary care doctors, specialists, therapists, counselors, hospitals, emergency rooms, and any alternative healthcare providers. For each provider, note the approximate dates of your visits and the conditions they treated.
Gather information about all diagnostic tests you’ve undergone, including X-rays, MRIs, CT scans, blood work, and psychological evaluations. You’ll need the dates these tests were performed and where they were conducted. If you have copies of test results, keep them handy for reference, though you won’t submit them with this form.
Create a detailed medication list that includes the name of each medication, dosage, frequency, prescribing doctor, and the condition it treats. Also note any side effects you experience from medications, as these can significantly impact your ability to work and function daily.
Work History Documentation: Gather employment records for the past 15 years, including W-2 forms, pay stubs, and employment letters. For each job, you’ll need the employer’s name and address, your job title, dates of employment, hours worked per week, and your rate of pay. If you were self-employed, collect tax returns and business records that show your earnings and work activities.
Write detailed descriptions of the physical and mental demands of each job. Consider factors like how much weight you lifted, how long you stood or sat, whether you worked with your hands, the level of concentration required, and any supervisory responsibilities. These job descriptions are crucial because the SSA will compare your past work demands to your current functional limitations.
Daily Activities Information: Before completing the form, spend a few days tracking your daily activities and limitations. Note what tasks you can perform, which ones are difficult or impossible, and how long it takes you to complete routine activities. Pay attention to how your symptoms vary throughout the day and week, as this information helps paint a complete picture of your functional capacity.
Step-by-Step Section Instructions
Section 1: Personal Information and Contact Details
This opening section establishes your identity and ensures the SSA can contact you throughout the claims process. While straightforward, accuracy is essential because errors can cause processing delays.
Lines 1-3: Name and Social Security Number Enter your full legal name exactly as it appears on your Social Security card. If you’ve recently changed your name due to marriage, divorce, or legal proceedings, use your current legal name but be prepared to provide documentation of the name change. Double-check your Social Security number, as even small errors can cause significant delays in processing your claim.
Lines 4-6: Contact Information Provide your current mailing address, even if it’s temporary. If you’re staying with friends or family, use that address but indicate the arrangement in the margins. Include a reliable phone number where you can be reached during business hours. If you only have a cell phone, provide that number and ensure your voicemail greeting is professional.
Line 7: Alternate Contact Person List someone who can reach you if the SSA cannot contact you directly. This should be a reliable person who knows your whereabouts and can relay important messages. Include their relationship to you and complete contact information.
Section 2: Claim Information and Application Details
Lines 8-10: Type of Benefits and Application Date Clearly indicate whether you’re applying for SSDI, SSI, or both. If you’re unsure which benefits you’re eligible for, you can apply for both and let the SSA determine your eligibility. Provide the exact date you submitted your initial application, as this affects your potential back-pay period.
Line 11: Alleged Onset Date This is one of the most important dates in your entire application. The alleged onset date is when you believe your condition became severe enough to prevent you from working. This date doesn’t have to be when you were first diagnosed or when you stopped working – it’s when your condition reached disabling severity.
Consider this date carefully because it affects your eligibility period and potential back-pay. The date should align with medical evidence showing significant worsening of your condition. If you continued working past this date, be prepared to explain how your work was affected and why you eventually had to stop.
Section 3: Medical Conditions and Impairments
This section requires you to list all medical conditions that limit your ability to work. The SSA considers the combined effect of all your impairments, so include every condition that affects your functioning, even if it seems minor.
Primary and Secondary Conditions List your most severe condition first, followed by other impairments in order of how much they limit your activities. For each condition, provide the specific medical diagnosis if you know it. If you don’t know the exact medical term, describe the condition in your own words, such as “constant back pain with shooting pain down my legs.”
When Conditions Started Provide the approximate date when each condition began affecting your daily life or work ability. This might be different from when you were first diagnosed. For example, you might have been diagnosed with diabetes years ago, but it only became disabling when complications developed.
How Conditions Limit You For each condition, briefly describe how it prevents you from working or performing daily activities. Focus on functional limitations rather than just symptoms. Instead of writing “I have depression,” explain “My depression makes it hard to concentrate, remember instructions, and interact with coworkers.”
Section 4: Healthcare Provider Information
Complete accuracy in this section is crucial because the SSA will request medical records from these sources. Incomplete or incorrect provider information can significantly delay your claim.
For each healthcare provider, include their full name, complete address with ZIP code, phone number, and your patient identification number if you know it. List the approximate dates of your first and most recent visits, and specify what conditions they treated.
Types of Providers to Include:
- Primary care physicians
- Specialists (cardiologists, neurologists, psychiatrists, etc.)
- Mental health professionals (therapists, counselors, psychologists)
- Hospital emergency departments
- Urgent care centers
- Physical therapists and occupational therapists
- Chiropractors and alternative medicine practitioners
Don’t limit yourself to providers you’ve seen recently. If a doctor treated your condition two years ago and has relevant medical records, include them. The SSA wants to see the progression of your condition over time.
Section 5: Hospitalization and Medical Tests
List all hospitalizations, emergency room visits, and outpatient procedures related to your disabling conditions. Include the facility name, complete address, dates of admission and discharge, and the reason for the hospitalization.
For diagnostic tests, include CT scans, MRIs, X-rays, blood work, psychological testing, and any other studies performed to evaluate your conditions. Provide the date of each test, where it was performed, and what condition was being evaluated.
Section 6: Medications and Medical Equipment
Current Medications List all prescription medications you take, including the medication name, dosage, how often you take it, who prescribed it, and what condition it treats. Include medications for mental health conditions, pain management, and any other health issues.
Don’t forget to include over-the-counter medications you take regularly, especially pain relievers, sleep aids, or supplements recommended by your doctor. Also list any medications you’ve tried but stopped taking due to side effects or lack of effectiveness.
Side Effects This is critically important information that many applicants overlook. Medication side effects can be as disabling as the underlying condition. Common disabling side effects include drowsiness, dizziness, nausea, cognitive problems, weight gain, and difficulty concentrating.
Describe specific ways these side effects impact your daily functioning. For example, “My pain medication makes me too drowsy to drive safely” or “My medication causes confusion that makes it hard to follow multi-step instructions.”
Medical Equipment List all assistive devices you use, including wheelchairs, walkers, canes, braces, oxygen equipment, CPAP machines, hearing aids, or any other medical equipment. Include when you started using each device and who prescribed it.
Section 7: Work History – Past 15 Years
This section is crucial because the SSA will compare the demands of your past work to your current functional limitations. Provide detailed information about each job you’ve held in the past 15 years, starting with your most recent position.
For Each Job, Include:
- Employer name and complete address
- Job title and your employee identification number if known
- Dates of employment (month and year)
- Hours worked per week and rate of pay
- Detailed description of job duties and responsibilities
- Physical demands (lifting, walking, standing, sitting)
- Mental demands (concentration, decision-making, interaction with others)
Job Descriptions Write detailed descriptions of what you actually did in each job, not just your official job title. Explain the physical requirements: How much weight did you lift regularly? How many hours did you stand, sit, or walk? Did you climb, crawl, or work in awkward positions?
Describe the mental and social demands: Did you supervise others? Handle money? Make decisions? Work under deadlines? Interact with customers or coworkers? The more detailed your descriptions, the better the SSA can understand how your current limitations prevent you from returning to this type of work.
Section 8: Education and Training
Provide information about your educational background, including the highest grade completed, any special education services received, and vocational training or certifications earned. This information helps the SSA determine what other types of work you might be able to perform given your limitations.
Include any literacy limitations, learning disabilities, or cognitive impairments that affected your education. If you didn’t complete high school due to health problems, mention this as it may be relevant to your current claim.
Section 9: Daily Activities and Functional Limitations
This section is critical because it shows how your conditions affect your ability to perform basic activities of daily living. The SSA uses this information to assess your overall functional capacity and determine whether you can sustain work activity.
Personal Care Activities Describe your ability to bathe, dress, groom, and care for personal hygiene. If you need help with any of these activities or if they take significantly longer than normal, explain this in detail. For example, “I can shower but need to sit on a shower chair and rest afterward due to fatigue and dizziness.”
Household Activities Explain what household tasks you can perform and which ones are difficult or impossible. Include information about cooking, cleaning, laundry, shopping, and home maintenance. If you can only perform these activities with help or modifications, describe the assistance you need.
Social Activities and Relationships Describe how your conditions affect your ability to interact with family, friends, and community members. Do you avoid social situations due to anxiety, depression, or physical symptoms? Has your personality or behavior changed due to your conditions?
Concentration and Memory Explain any problems with concentration, memory, following instructions, or completing tasks. These cognitive limitations can be as disabling as physical impairments and are particularly important for mental health conditions.
Section 10: How Your Conditions Affect Work-Related Activities
This section directly addresses your ability to perform work-related functions. Be specific about how your conditions limit each activity listed on the form.
Physical Limitations Describe limitations in sitting, standing, walking, lifting, carrying, reaching, handling objects, and other physical activities. Include information about pain, fatigue, weakness, balance problems, and endurance limitations. Use specific examples: “I can only stand for 10-15 minutes before severe back pain forces me to sit down.”
Mental Limitations Explain problems with concentration, memory, understanding instructions, making decisions, handling stress, and interacting with supervisors or coworkers. Mental limitations can be harder to describe than physical ones, but they’re equally important to document thoroughly.
Environmental Limitations Note any restrictions related to exposure to temperature extremes, dust, fumes, heights, machinery, or other environmental factors. Some medical conditions make certain work environments dangerous or impossible.
Common Mistakes to Avoid
Incomplete Medical Provider Information Many applicants provide partial information about their healthcare providers, making it difficult for the SSA to obtain medical records. Always include complete names, addresses, phone numbers, and patient identification numbers when possible.
Underestimating the Impact of Symptoms Don’t minimize how your conditions affect your daily life. Some applicants worry about appearing to complain or exaggerate, but the SSA needs to understand the full extent of your limitations. Be honest about your worst days as well as your better days.
Focusing Only on Diagnosis Rather Than Functional Limitations The SSA is more interested in how your conditions limit your functioning than in the specific diagnoses you have. Always explain what you can’t do or what’s difficult for you to do, not just what medical conditions you have.
Inconsistent Information Make sure your responses are consistent throughout the form and align with information in your medical records. Contradictory information can raise questions about the credibility of your claim.
Timeline Expectations and What Happens Next
After you submit Form SSA-3368, the SSA will begin the disability determination process. Understanding this timeline helps you prepare for what comes next and reduces anxiety about the process.
Initial Review Period (30-45 days) The SSA will review your application for completeness and may contact you if additional information is needed. During this time, they’ll also begin requesting medical records from the providers you listed on your form.
Medical Evidence Development (60-90 days) The SSA will gather medical records, may schedule consultative examinations, and might request additional information from you or your healthcare providers. This is often the longest part of the process.
Disability Determination (30-60 days) A disability examiner and medical consultant will review all evidence and make an initial determination on your claim. You’ll receive a written decision explaining whether your claim was approved or denied.
Important Information About Processing Times:
- Initial claims typically take 3-6 months to process
- Complex cases or those requiring additional medical evidence may take longer
- Holidays and high claim volumes can extend processing times
- You can check your claim status online at www.ssa.gov
Getting Help with Your Application
Completing Form SSA-3368 thoroughly and accurately is crucial for your disability claim’s success. If you need assistance, several resources are available to help you navigate this complex process.
Free Resources:
- Social Security Administration offices provide free assistance with applications
- Many community organizations offer disability application help
- Some legal aid societies provide free services for disability applicants
- AARP and other advocacy organizations offer guidance and support
When to Consider Professional Help: If your case involves complex medical conditions, substantial work history, or previous denials, you might benefit from professional assistance. Disability attorneys and advocates specialize in navigating the Social Security system and can help ensure your application is complete and persuasive.
Red Flags to Avoid: Be cautious of services that charge upfront fees for help with your initial application. Legitimate disability attorneys and advocates work on contingency, meaning they only get paid if your claim is approved. Never pay someone who promises to guarantee approval or claims to have special connections within the SSA.
The path to disability benefits can be challenging, but thorough preparation and accurate completion of Form SSA-3368 significantly improve your chances of approval. Take your time, gather all necessary information, and don’t hesitate to seek help when you need it. Your careful attention to detail in completing this form is an investment in your future financial security and peace of mind.
Remember that the SSA wants to approve claims for people who truly cannot work due to their medical conditions. By providing complete, accurate, and detailed information on Form SSA-3368, you’re helping them understand your situation and make an informed decision about your eligibility for benefits.
This article is for informational purposes only and does not constitute legal or medical advice. Always consult with qualified professionals for guidance specific to your situation. For the most current forms and information, visit the official Social Security Administration website at www.ssa.gov.
Need Additional Help?
- Contact the Social Security Administration at 1-800-772-1213
- Visit your local SSA office for in-person assistance
- Explore additional disability resources at DisabilityResources.org
- Consider consulting with a qualified disability attorney or advocate if your case is complex