Describe your WORST days, not your best days

Be specific: 'I can stand for 5 minutes before my back pain forces me to sit' is better than 'I can't stand long'

If someone helps you with daily activities, say so and explain why

Social Security Disabilityvery hard

Function Report

SSA-3373-BK · SSA

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

Form Details

Total fields: 95
Auto-fillable: 30 (32%)
Time without BeneFill: 75 minutes
Time with BeneFill: 20 minutes
Time saved: 55 minutes
Filled by: patient
Frequency: one time

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Where to Submit This Form

📬

Return to your local SSA office or the address provided

SSA typically sends this form to you — return it to the address on the form.

Filing Deadline

Usually 30 days from when SSA sends it to you. Call SSA for an extension if needed.

Processing Time

Part of the disability application — processed with your claim.

Tips for This Form

✓ Describe your WORST days, not your best days
✓ Be specific: 'I can stand for 5 minutes before my back pain forces me to sit' is better than 'I can't stand long'
✓ If someone helps you with daily activities, say so and explain why

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