Social Security Disability Form 3368: Adult Disability Report

Learn about the disability report, a key part of your Social Security disability application.

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Anyone filing for Social Security disability will find that there are many forms that must be filled out along the way. One of the forms you will first encounter in this process is Form SSA 3368, the Disability Report form for adults.

How Is Form 3368 Filed?

Form 3368 is filed with the Social Security Administration (SSA) when you apply for Social Security Disability (SSDI) or SSI disability benefits. For SSDI applicants, this Adult Disability Report is now part of the main online disability application. If you want to file online, you can gather your medical history first and fill it out at your leisure in your own home. Or, if you choose to go in to your local Social Security office, you can fill the 3368 disability report form during your disability interview with the Social Security claims representative. Applying for your Social Security disability benefits in person has some advantages, one of which is the ability to ask questions about anything you don't understand, including questions or information requested on the 3368.

What Do You Put on Form 3368?

Informally, Form 3368 is sometimes called the Pain and Function Report. On Form 3368 you will describe the nature of your disability, whether your impairments are physical or mental, the date of onset (when your symptoms began), what type of medical treatment you have received and the medical facilities at which you received it, and so on. You should provide as many details on Form 3368 as possible regarding your symptoms and your medical history.

In the section that asks how your condition keeps you from working, include why you can't do your past jobs as well as any type of job. Here's a sample of a filled-out Form 3368.

Where Does Form 3368 Form Go?

This disability report form is the launching point from which your entire medical eligibility decision will evolve —: after you fill it out, an SSA claims rep forwards Form 3368 directly to Disability Determination Services (DDS), the state agency that makes the initial determination on whether an applicant is medically disabled for the federal Social Security Administration (in a few states it is not called DDS, but something similar).

At DDS, your case is assigned to a disability claims examiner, who uses the disability report form to begin evaluating your claim. The more information you provide, the more the examiner has to work with at the outset. Making sure that you have listed correct contact information for your physicians, as well as the locations at which you have received medical care, will help your case move through the system more quickly. If your form is incomplete or the information you provided is sketchy, the disability examiner will have to follow up with you and waste time looking for correct names or phone numbers so that he or she can get your medical records. These delays can actually hold your case up for months.

Should You Have an Attorney Fill Out Form 3368?

Most disability attorneys will not agree to represent you from the very start of your case -- they won't take a case until it has been denied by DDS and is being appealed. If you have an obvious case of disability, however, and you need help filling out the form, you might be able to find an attorney to take your case. An experienced disability attorney will be well-versed in filling out this form and will know what to emphasize on this form as well as the many other disability forms you'll encounter during the disability determination process, including the doctor's RFC form.

Learn more about the other Social Security forms you'll need to fill out as part of your disability application.

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