What Is Form SSA-4734? Understanding the Residual Functional Capacity (RFC) Assessment

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Written By Jacky Writes

A quiet form inside your Social Security Disability file—Form SSA-4734—often carries more weight than most people realize. It’s not something you fill out or even see during your application, but it can deeply shape how the Social Security Administration (SSA) decides whether your medical condition limits your ability to work.

How Form SSA-4734 Fits Into the SSDI Process

After you apply for Social Security Disability Insurance (SSDI), your case is transferred from your local SSA field office to your state’s Disability Determination Services (DDS). According to the SSA’s Program Operations Manual System (POMS DI 70050.000), DDS examiners and medical consultants review every piece of medical and vocational evidence before making a decision.

Form SSA-4734-BK, officially titled the Physical Residual Functional Capacity Assessment, is part of that review. It’s completed by a DDS medical consultant, who uses it to record their professional judgment about what you can still do physically—your Residual Functional Capacity (RFC)—based on all the medical evidence in your file.

What Form SSA-4734 Evaluates

Unlike your doctor’s office notes, Form SSA-4734 isn’t focused on diagnosing conditions—it’s about functionality. The goal is to capture how your medical limitations translate into everyday work abilities.

The form asks the DDS medical consultant to evaluate:

Physical Abilities

  • How long you can sit, stand, or walk during an eight-hour day

  • How much you can lift, carry, push, or pull

  • Your ability to reach, handle, or use your hands and fingers

  • Your capacity to climb, balance, stoop, kneel, crouch, or crawl

Environmental and Postural Limits

  • Tolerance for heat, cold, humidity, fumes, or vibration

  • Sensitivity to noise, dust, or hazards like machinery

Narrative Summary

The consultant writes a narrative explaining how the medical evidence supports each finding. This ties together test results, clinical observations, and your self-reported daily activities (which may come from your Form SSA-3373, the Adult Function Report).

If you’d like to see what Form SSA-4734 looks like, you can view a publicly available copy through the Indiana state government’s website: Form SSA-4734-BK (Physical Residual Functional Capacity Assessment)

How SSA-4734 Influences Disability Decisions

The Residual Functional Capacity (RFC) recorded on Form SSA-4734 becomes central in Steps 4 and 5 of SSA’s five-step sequential evaluation process:

Step 4: Can you perform any of your past relevant work?

Step 5: If not, can you adjust to other work that exists in significant numbers?

The SSA uses the RFC findings to match your abilities against jobs listed in the Dictionary of Occupational Titles (DOT). For example, an RFC that limits lifting to 10 pounds might rule out most “medium” or “heavy” jobs but still allow certain sedentary positions.

If the RFC shows very limited physical capacity, it may support a disability finding under SSA rules.

Why You Won’t Fill Out or See Form SSA-4734 Yourself

Applicants never complete this form because it’s an internal SSA document, used only by DDS staff and medical consultants. However, if you request a copy of your case file (for example, during an appeal), you can usually find the completed SSA-4734 among your records. Reviewing it can help you understand how SSA interpreted your medical evidence.

Who Completes Form SSA-4734 — and Is It Based on an Exam?

Form SSA-4734 (Physical Residual Functional Capacity Assessment) is completed by a DDS medical consultant—a licensed physician or psychologist who works for your state’s Disability Determination Services (DDS).

This consultant does not examine you in person. Instead, they review the entire medical file that’s already been collected for your disability claim. That file may include:

  • Reports from your treating doctors or specialists

  • Results from any consultative examination (CE) the DDS may have ordered earlier in the process

  • Hospital, clinic, or laboratory records

  • Function reports such as Form SSA-3373, which describe your daily activities

The consultant then uses this existing evidence to form a professional medical opinion about your physical abilities—how long you can sit, stand, lift, or walk—and records that opinion on Form SSA-4734.

You don’t attend an appointment for this form, and no new exam is scheduled because of it. The SSA-4734 simply reflects the consultant’s interpretation of the medical information already in your record.

In short: Form SSA-4734 shows how DDS doctors interpret your past exams and records—not a new exam of their own.

When a Consultative Exam May Happen

Sometimes, before the SSA-4734 is completed, the DDS examiner finds that your medical file doesn’t include enough current or detailed information. In those cases, they may schedule a Consultative Examination (CE) with an independent doctor to fill in the gaps.

That CE report then becomes part of your evidence file—the same file the medical consultant later reviews when completing Form SSA-4734.

Summary: A Behind-the-Scenes Medical Opinion That Matters

Form SSA-4734 is the official medical consultant’s opinion on paper—a professional analysis of what your medical evidence says about your ability to function in a work setting.
You’ll never fill it out yourself, but it’s one of the most important forms in your SSDI claim. Supplying complete, up-to-date medical records—and responding promptly to any requests for a consultative exam—can help ensure your RFC is based on the fullest possible evidence.

FAQ

Q: Is the SSA-4734 based on an exam?
A: Not on a new or separate exam. The form is completed by a DDS medical consultant after reviewing all of your existing medical evidence—such as reports from your doctors, hospital records, and any consultative exam the DDS may have already scheduled. You don’t attend an exam specifically for this form. Instead, the consultant uses those prior records and exam results to form a professional opinion about your physical abilities.
(Source: SSA POMS DI 24501.001, https://secure.ssa.gov/poms.nsf/lnx/0424501001; SSA POMS DI 24510.050, https://secure.ssa.gov/poms.nsf/lnx/0424510050)

Q: Who completes the SSA-4734 form?
A: A licensed physician or psychologist employed or contracted by your state’s Disability Determination Services (DDS).
(Source: SSA POMS DI 70050.000, https://secure.ssa.gov/poms.nsf/lnx/0900705000)

Q: How does the SSA use Form SSA-4734?
A: The RFC findings on the form help determine whether you can do past work or other work under SSA’s five-step disability evaluation.
(Source: SSA POMS DI 24510.050, https://secure.ssa.gov/poms.nsf/lnx/0424510050)



References

Disclaimer: This article is for informational purposes only and does not constitute medical or legal advice. Consult with a qualified healthcare provider for any medical concerns or questions. Consult with a licensed attorney for legal advice.

AI Ethical Statement: This article includes information sourced from government and reputable health websites, reputable academic journals, non-profit organizations, and was generated with help from AI. A human author has substantially edited, arranged, and reviewed all content, exercising creative control over the final output. People and machines make mistakes. Please contact us if you see a correction that needs to be made.



Jacky Writes
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Form SSA-16: Your First Step to Applying for Social Security Disability Insurance (SSDI)