Filling Out The Adult Disability Report Form SSA-3373-BK

After you have made a Social Security Disability claim and have had your initial interview, you may be asked to fill out Form 3373-BK, the Adult Disability Report. This form is designed to be filled out by yourself, without the aid of medical or other professionals.

On the one hand, if you are asked to fill out this form, you should take that as a good sign that your Social Security Disability claim is being considered seriously enough that the examiner felt that he needed additional information from you.

On the other hand, much of the information the SSA is seeking is designed to demonstrate that you are still capable of performing gainful employment. Therefore, you should use caution with your answers. Be truthful, but be aware that certain kinds of answers can lead to your Social Security Disability claim being denied (at least initially).

While you do need to fill this form out yourself, you can ask for counsel from your Social Security Disability attorney. If you aren’t already working with one, it's a good idea to speak with a Social Security Disability attorney at this early stage of the process. Your chances of having your claim approved increased significantly with the help of competent counsel.

Filling Out The Adult Disability Report Form SSA-3373-BK

Form 3373-BK is a ten page form consisting of five sections.

The first section (Section A) asks basic information such as your name and contact information. The remaining four sections ask questions regarding your day to day activities and routines to help the Social Security Administration decide whether you should be considered completely disabled.

Section B asks about your disabilities and how they hinder you from working. It is in your best interest to be very informative here. Remember, you are building a case to show that you should be eligible for Social Security Disability benefits because you are completely unable to perform work. List every disability you have, and describe in detail how is hinders your ability to work. Include any reasons why you would not be able to perform work for 8 hours and day, five days a week. For example, if you're unable to do something consistently, or "only on good days" due to your condition, include that information. Be sure to focus on why you are unable to work now, rather than your ability to work in the past.

Section C asks some seemingly innocuous questions which are designed to show that you may still be able to function on a day to day basis in some way which would make you employable (and thus ineligible for Social Security Disability benefits). The questions asked involve whether you care for children or pets; whether your condition affects your ability to sleep; and what your daily routines are. Be sure to describe how your condition can affect your daily activities. If you need help with any daily activities, describe the type, of help, how often you need the help, and how long you need the help for that activity.

Be aware when filling out Section C that the SSA can interpret activities such as watching television programs as the ability to sit down for long periods without interruption (and thus an ability to perform sedentary work). If your daily activities demonstrate that you can sit for several hours at a time, stand for several hours at a time, or lift significant amounts of weight; your claim is likely to be denied (though you can appeal the decision).

Make sure you mention any condition that makes self care asked about in Section C more difficult. You want to paint a picture of yourself as having difficulty doing anything without assistance, at least inasmuch as you can do so and still answer the questions truthfully.

Section D poses a series of checklists and questions designed to determine whether you are capable of performing any work. While you should answer all questions honestly, be aware that every question on the form is designed to demonstrate that you may be capable of performing some form of work (this disqualifying you from Social Security Disability), so you will want to be careful how you answer. The end of the section asks about medications you are taking.

The final section (Section E) offers you an opportunity to add any information which you believe is pertinent. If there is any information regarding your disability which does not seem to fit in the other sections, make sure to include it in as much detail as possible in Section E.

If you're ever in doubt as to what you would need to include in your Adult Disability Report Form, you may want to contact a disability advocate or attorney about your case. They can give you guidance through the process, and help you appeal the SSA's decision if needed.

Additional Resources