SSA-3373 Function Report Completion Checklist
Checklist for Form 3373 - SSDI Function Report
Use this to ensure your responses are accurate, consistent, and helpful to your SSDI claim:
🗂 General Preparation
Gather your medical records, SSA-3368, and any prior Function Reports.
Request more time from SSA if you need it (you typically get 10 days).
Use a draft version first. Don’t write directly on the original form until you're ready.
Use the remarks section or extra pages when you need more room.
📋 Section-by-Section Review
Section A – General Information
Double-check your name, address, and identifying information.
Example: If you’ve moved since applying, make sure the address here matches your SSA contact file.
Section B – Medical Conditions
List all conditions that impact your functioning—not just your main diagnosis.
Describe how each condition affects your daily activities and abilities.
Example: "My diabetic neuropathy causes numbness in both feet, making it difficult to walk more than 100 feet without needing to stop and rest. I often trip or lose balance, especially when walking on uneven surfaces."
Section C – Daily Activities
Focus on your worst days—not occasional good ones.
For each task (dressing, bathing, cooking):
How often do you do it?
How long does it take?
Do you need help or use assistive devices?
What symptoms limit you—pain, fatigue, confusion?
Example: "I use a stool to sit while showering. I can only stand for about 3 minutes before my legs go numb. My spouse helps me wash my hair."
Section D – Functional Abilities
Describe physical limitations (sitting, standing, lifting, walking).
If you use assistive devices that were not prescribed—like a store-bought cane, ergonomic keyboard, or home-modified tools—explain how and why you use them. Be honest that they weren’t prescribed but describe the necessity and impact they have on your ability to function.
Example: "Although my cane was not prescribed by a doctor, I purchased it myself because I fall without it when walking more than a block."
Include any mental or cognitive issues (concentration, memory, following instructions).
Note side effects of medications that affect daily functioning.
Example: "I cannot sit for more than 20 minutes without pain. I forget steps when cooking, even with written instructions, due to medication-induced brain fog."
Section E – Remarks
Use this section to explain or clarify responses you couldn’t fully detail earlier.
Include additional examples that clarify how symptoms vary from day to day—especially on your worst days—without repeating earlier responses. Focus on scenarios that illustrate variability, flare-ups, or limitations that aren’t fully explained elsewhere.
Point out any additional context like how often you need help, what happens when you push beyond your limits, or how multiple impairments interact.
Example: "On bad days, I have to lie down for 4–6 hours due to migraines and light sensitivity. During this time, I can't prepare meals or even watch TV because the light and sound worsen my symptoms."
Make sure responses in this section enhance—not repeat—earlier answers. Think of it as your chance to make the SSA understand the real impact of your impairments.
What NOT to Do in Section E:
Don’t leave it blank if you have more to explain.
Don’t copy-paste earlier answers—use this to add value.
Don’t introduce new conditions not listed on SSA-3368.
Don’t vent about SSA—stick to helpful facts.
Don’t use vague phrases like "I just feel bad." Be specific.
Don’t forget to label any continued answers with the question number.
🔍 Final Review
Are your answers specific, detailed, and free from contradictions?
Do your descriptions match what your medical records show?
Compare your answers to the doctor's notes, imaging results, and functional assessments.
For each major symptom or limitation you report, ask: “Is there something in my records that supports this?”
If your records mention limitations (e.g., difficulty walking, lifting, or sitting), make sure your form describes how these show up in your daily life.
If your doctor says you can’t stand for long periods, don't say you cook dinner daily unless you clarify it’s with frequent breaks or help.
Be especially consistent with the severity and frequency of symptoms like pain, fatigue, confusion, or panic attacks.
Have you explained help, tools, or adjustments you rely on?
Did you describe symptoms and side effects, including emotional and mental effects?
Did you make a copy of the final form for your records?
Completing Form SSA-3373 isn’t just about listing your daily tasks—it’s about painting a truthful and complete picture of how your condition limits your ability to function. Strategy matters just as much as honesty. When your responses are detailed, consistent with your medical records, and clearly describe your worst days, you're giving your claim the strongest possible foundation. Think of this checklist as your roadmap: follow it thoughtfully, use your medical evidence as a compass, and give yourself the time and space to do it right.
You can download the official SSA-3373 Form on the SSA website.
