Tip for SSA or insurer-specific

This is one of the most important forms in a disability case — it quantifies what you CAN and CANNOT do

Tip for SSA or insurer-specific

Ask your doctor to be specific: 'Can lift no more than 5 lbs' is better than 'limited lifting'

Tip for SSA or insurer-specific

If you have multiple conditions, each treating specialist should complete a separate RFC form

Social Security DisabilityhardDoctor signature required

Residual Functional Capacity (RFC) Form

SSA or insurer-specific · SSA / Disability Insurance Carriers

Detailed assessment of specific physical and/or mental limitations such as sitting/standing hours, lifting capacity, and frequency of absences. Critical for both SSDI and LTD claims.

Form Details

Total fields: 60
Auto-fillable: 35 (58%)
Time without BeneFill: 45 minutes
Time with BeneFill: 12 minutes
Time saved: 33 minutes
Filled by: doctor
Frequency: per incident

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Where to Submit This Form

📬

Submit to SSA with your disability claim or appeal

Have your treating physician complete this form.

📠

Fax to your local SSA office

https://secure.ssa.gov/ICON/main.jsp

Required Attachments

📎 Must be completed by your treating physician
📎 Specific functional limitations: lifting, standing, walking, sitting, reaching, handling, concentration
📎 Supporting medical records and test results

Processing Time

Part of the overall disability claim — SSA reviews RFC evidence within the standard 3-6 month timeline.

What Happens Next

SSA's disability examiner will use this along with other evidence to determine your Residual Functional Capacity. This directly affects whether SSA finds you disabled under the 5-step sequential evaluation.

Tips for This Form

✓ This is one of the most important forms in a disability case — it quantifies what you CAN and CANNOT do
✓ Ask your doctor to be specific: 'Can lift no more than 5 lbs' is better than 'limited lifting'
✓ If you have multiple conditions, each treating specialist should complete a separate RFC form

More Social Security Disability Forms

SSDI Application

SSA-16-BK · SSA

Application for Social Security Disability Insurance Benefits. Requires detailed work history, earnings record, and medical condition documentation.

SSI Application

SSA-8000-BK · SSA

Application for Supplemental Security Income for aged, blind, and disabled individuals with limited income and resources. Must be completed via SSA interview.

Adult Disability Report

SSA-3368-BK · SSA

The most complex patient-facing disability form. 15 pages requiring complete medical history, all diagnoses, medications, treating providers, hospitalizations, and work history.

Work History Report

SSA-3369-BK · SSA

10-page report requiring detailed descriptions of all jobs held in the past 15 years including physical demands, tools used, supervision, and lifting requirements.

Function Report

SSA-3373-BK · SSA

10-page functional assessment covering ADL capacity, daily routines, social functioning, cognitive abilities, and physical limitations.

Authorization to Disclose Information

SSA-827 · SSA

Authorization allowing SSA to collect medical and other information from providers, hospitals, and other sources for disability determination.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the SSA / Disability Insurance Carriers or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.