How to Complete SSA Form 3373-BK (Function Report) for SSDI claims: 2025 Guide
If you’re applying for SSDI disability, you’ll likely be asked to fill out Form 3373. SSA Form 3373 isn’t about your diagnosis—it’s about what you can no longer do. And the way you answer can shape your entire disability claim.
This isn't just paperwork. It's your voice in a system that doesn’t see your pain unless you spell it out, step by step.
In this guide, we’ll give you examples on how to fill out Form SSA-3373-BK—the Social Security “Function Report”—and explain how disability examiners interpret your responses in the context of your overall SSDI claim.
You’ll get:
12 strategic tips based on federal court rulings and SSA policies,
Real-world examples that clarify confusing sections,
A downloadable checklist to guide your answers.
Let’s help you tell your story.
What Is Form SSA-3373-BK?
Form SSA-3373-BK is the Adult Function Report used by the Social Security Administration (SSA) to evaluate how your medical condition affects your ability to perform everyday tasks and maintain employment. The form contains five sections:
General Information (Section A)
Medical Conditions (Section B)
Daily Activities (Section C)
Functional Abilities (Section D)
Remarks (Section E)
SSA uses this form to help assess your Residual Functional Capacity (RFC), which influences whether you qualify for disability benefits.
Why SSA Sends You This Form
Most claimants receive this form during the initial or reconsideration phase of their SSDI or SSI application. You typically have 10 days to complete and return it. SSA uses your responses to determine how your condition limits your daily function—but if you don’t return the form, your claim may be denied for non-cooperation. Some claimants (such as those under Compassionate Allowance or TERI status) may be exempt if SSA already has sufficient medical evidence.
How SSA Uses Your Responses
SSDI Disability examiners at the state DDS (Disability Determination Services) offices and Administrative Law Judges (ALJs) use Form 3373 not only to understand limitations but also to identify possible work-related capabilities.
Your responses are checked against:
Medical records
Previous statements or Function Reports
According to POMS DI 24501.021, a section in the SSA’s Program Operations Manual System, SSA analysts examine how your symptoms—such as fatigue, confusion, or pain—impact your ability to function in six domains: understanding and memory, sustained concentration, social functioning, adaptation, and more. This means that saying you "do laundry" without explaining the time, help, or effort involved could undermine your claim.
Consistency across all evidence is essential. Even minor inconsistencies can be used to deny a claim, so make sure your Function Report aligns with your medical documentation and previous forms.
Key Types of Evidence SSA Compares Against form 3373
Medical Records: Office visit notes, diagnostic tests, and treatment history
Physician Statements: Especially RFC assessments from treating doctors
SSA-3368: The main Disability Report
Prior Function Reports: Including earlier versions or third-party versions (SSA-3380)
Testimony or Interviews: What you say in hearings or CE exams
Medication Side Effects: Documented effects that limit function
Being aware of these comparison points can help you complete the Function Report with clarity and foresight.
Form SSA-3373: What the Courts Say: Case Spotlight – Shelley C. v. Commissioner
In this Fourth Circuit case, the court faulted an Administrative Law Judge (ALJ) for failing to explain why consistent Function Report responses were not credited. The decision emphasized that Function Reports can strongly support a disability claim when they align with medical records and are presented credibly. The court also criticized the ALJ for offering only boilerplate reasoning without tying findings to specific evidence, reinforcing the legal requirement for detailed, individualized analysis.
Critical Judicial Principles
Courts typically apply these standards when reviewing SSA-3373 evaluations:
Consistency Requirement: ALJs must explain how Function Report entries align or conflict with medical imaging, physician notes, and objective testing.
Contextual Analysis Mandate: Descriptions of daily activities must consider frequency, duration, assistance required, and symptom impact.
Anti-Boilerplate Doctrine: Generic phrases like "daily activities inconsistent with disability" are legally insufficient unless backed by specific evidence.
Worst-Day Framework: ALJs are expected to consider that Function Reports may reflect worst-day scenarios, not average functioning.
These principles mean that while judges have some flexibility in how they interpret a Function Report, they must clearly explain how answers match up—or don’t—with the rest of medical and work history. Take care to fill out your forms so they are specific, consistent, and well-documented.
The SSA operating manual under POMS DI 24510.006 instructs adjudicators to focus on whether claimants can perform activities consistently and on a sustained basis—not just occasionally. In other words, SSA is interested in how well someone can maintain tasks day after day, not only on their better days.
Section-by-Section Guide to Form SSA-3373
For Educational Purposes Only. This is not legal advice. Please consult an attorney for legal advice. We are not attorneys.
Section A – General Information
Make sure your personal information is complete and matches other SSA documents. This includes your name, address, and identifying details.
Section B – Information About Illnesses, Injuries, or Conditions
List all physical and mental health conditions that limit your daily activities (not just the main diagnosis). Consider specifics about each condition’s impact.
Section C – Information About Daily Activities
Describe how your condition affects what you do each day. Consider the hardest days. For each task (like cooking or dressing), you can explain:
How often you do it
How long it takes
If you need help or assistive devices
What symptoms (like pain or fatigue) interfere
Section D – Information About Abilities
Discuss what you can and cannot do physically, mentally, and emotionally. This is where you can talk about memory issues, anxiety, trouble following instructions, or focusing. You can also mention side effects from medications that impact your ability to work or function.
Section E – Remarks
Use this space to provide additional details that didn’t fit elsewhere. Clarify anything that might seem inconsistent. You can describe your symptoms on your worst days and how your condition changes over time.
What You Can Do:
Clarify inconsistencies with specific explanations.
Expand on previous answers using question numbers for reference.
Describe variability in symptoms (e.g., bad vs. better days).
Add mental, cognitive, or emotional effects that didn’t fit in other sections.
Mention how side effects from medications affect functioning.
What Not to Do:
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 mentioned in SSA-3368 or medical records.
Don’t use vague phrases or exaggerated claims.
Don’t vent about SSA or include complaints.
Don’t forget to label answers if continuing from a prior question.. Clarify anything that might seem inconsistent. Describe your symptoms on your worst days and how your condition changes over time.
Use this to explain any inconsistencies, elaborate on limitations, or add details you couldn't fit in earlier sections.
12 Tips to help with form SSA-3373
Be consistent with medical records – Conflicting answers can lead to denial. For example, if your medical records say you can't stand for more than 10 minutes due to back pain, it will be confusing is you also say that you clean the house daily without help. Instead, you could explain that you can only clean one room at a time, need breaks, or require assistance to avoid creating contradictions.
Consider Starting with Question 20 (Activities) – It sets the tone for the rest of the form.
Give detailed examples, not vague labels – Go beyond basic descriptions. When you say something like “I use a shower chair,” you can also explain how often you need it, how long the task takes, whether someone helps you, and what symptoms (like dizziness or weakness) make that assistance necessary. SSA needs a full picture to understand your true limitations. For example, instead of just saying “hygiene issues,” you can explain: “I use a shower chair because standing for more than five minutes causes severe back pain and dizziness. I also need help washing my hair because I can’t raise my arms overhead without pain.”
You can describe your worst days – SSA evaluates whether you can function consistently.
You can explain any help or modifications – Even partial assistance can be listed. For example, if you prepare meals but need to sit while chopping vegetables or rely on a microwave because you can’t stand long at the stove, you can say so. If a family member helps carry groceries or reminds you to take medication, you can include that. These details show the limits of your independence and help SSA understand the true extent of your impairments.
Cross-check with SSA-3368 – Avoid contradictions between forms.
You can mention assistive devices – Assistive technology isn’t just a convenience; it’s often a sign of substantial functional limitations. You can include any tools or devices you use—like canes, grabbers, reachers, or shower chairs. These can support your claim by showing the adaptations you need to get through daily life. For a deeper look at tools that support independent living, see our article on assistive technology for disability.
Include mental limitations and medication side effects – Don’t overlook these.
Be honest but avoid exaggeration or minimization – Credibility is crucial.
Use the remarks section wisely – Add key context or clarify complex answers.
Keep copies of everything – This helps with appeals or follow-ups.
Request extra time if needed – Rushed answers often miss important details.
Mistakes That WEAKEN THE VIEW OF YOUR DISABILITY
Leaving sections blank
Vague answers without examples
Reporting activities without describing help or limitations
Exaggerating symptoms
Forgetting to mention medication side effects
Sample Responses and Downloadable Checklist
Examples:
"When preparing meals, I have to sit on a stool because standing causes sharp hip pain after a few minutes. I use a timer to remind me to check food because I forget if I’ve turned off the stove."
"I can only focus on one task for 10–15 minutes at a time because my medication makes me drowsy and I lose concentration. If I try to push through, I get confused and frustrated."
You can review our Checklist for Form 3373 to help guide you through the process of filling out this long SSDI form.
FAQs
Who fills out Form SSA-3373?
Usually, the SSDI claimant must complete Form 3373. If you’re filing for SSDI, you are the SSDI claimant. Form 3373 is designed to capture your personal experience and limitations in your own words. However, according to POMS DI 11005.026, SSA may assist with completion or use an alternate process for individuals who are homeless, hard to contact, or otherwise unable to complete the form.
What is Form SSA-3380 and how is it different from SSA-3373?
Form SSA-3380, also known as the Function Report – Adult – Third Party, is completed by someone who knows the claimant well, like a spouse, friend, or caregiver. While SSA-3373 is filled out by the claimant, SSA-3380 offers a third-party perspective on how the claimant’s condition affects daily life. According to POMS DI 11005.016B.7, this form is not used in every case but is required when Disability Determination Services (DDS) needs more information from someone who knows you well.
Can someone help me fill out Form 3373?
Yes, someone can help you write the answers. The responses on the form must reflect the disabled person’s personal experience and limitations. The disclosure requirement on page 10 is essentially proof SSA allows someone to help. Form 3373 asks for the name and address of the disabled person at top, and the name and address of the person completing the form at the bottom. It’s common practice for disabled individuals to receive help with forms. Form 3373 also states in the instructions that you can call the person who asked you to fill out the form for help. The instructions for Form 3373 also has a reminder for the person filling out the form to make sure they enter their name and address at the bottom.
What happens if I don’t complete Form 3373?
SSA may deny your claim for failure to cooperate if you don’t return the form by the deadline. According to SSA policy, they may not proceed with evaluating your disability unless they have sufficient information. Form 3373 provides information to help evaluate a disability.
How long should I spend on this form?
Several hours over a few days is normal. Don’t rush. Take time to think through your limitations and cross-check with your medical records. Rushed answers often leave out crucial details or result in contradictions.
Conclusion: Honesty + Strategy = A Winning Form 3373
Filling out SSA-3373 isn’t just about telling the truth—it’s about telling it in a way that shows how your condition affects you every day. Combine honesty with strategy: be detailed, consistent with your medical records, and clear about your worst-day limitations. If you take your time and tell your truth clearly, you’ll give yourself the best chance to be heard and believed.
References
Social Security Administration. (n.d.). Form SSA-3373-BK. https://www.ssa.gov/forms/ssa-3373-bk.pdf
Social Security Administration. (n.d.). POMS DI 11005.026 - Function Report Use and Completion. https://secure.ssa.gov/apps10/poms.nsf/lnx/0411005026
Social Security Administration. (n.d.). POMS DI 24501.021 - Symptoms Evaluation. https://secure.ssa.gov/apps10/poms.nsf/lnx/0424501021
Social Security Administration. (n.d.). POMS DI 11005.016 - Collateral Information from Third Parties. https://secure.ssa.gov/apps10/poms.nsf/lnx/0411005016
United States Court of Appeals for the Fourth Circuit. (2022). Shelley C. v. Commissioner of Social Security, No. 21-2042. https://www.ca4.uscourts.gov/opinions/212042.p.pdf
Disclaimer: This article is for informational purposes only and does not constitute medical or legal advice. Consult with a qualified healthcare provider for medical questions. Consult with a licensed attorney for legal advice. This article does not create an attorney-client or doctor-patient relationship.
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