Adult Disability Report (SSA-3368-BK): How to Fill It Out

Key Takeaways

• The Adult Disability Report is a required 15-page form for all adults applying for Social Security disability benefits.

• The Adult Disability Report explains to Social Security what your disabilities are and how they prevent you from working.

• You must be consistent with all the other disability forms you complete, such as the Work History Report, so that everything aligns.

What is Form SSA-3368?

The Adult Disability Report (Form SSA-3368) is a document that informs the Social Security Administration about a disability applicant’s condition and inability to work. Form SSA-3368 outlines important details about the applicant’s disability, limitations, and work history. It also summarizes medical history and includes contact details for healthcare providers.

The Social Security Administration and Disability Determination Services use the information on Form SSA-3368 to determine an applicant’s technical eligibility and medical eligibility for benefits. 

If you’re applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), you must complete the Adult Disability Report (Form SSA-3368-BK) as part of the application process. Form SSA-3368 includes questions about your medical condition and work history. Here's what you need to know to fill it out.

Fair warning: The Adult Disability Report is 15 pages long and takes about 90 minutes to complete.

How to Fill Out the Adult Disability Report (Form SSA-3368-BK)

The Adult Disability Report is a required form for individuals applying for Social Security disability benefits. The only exception is minors, who use the Child Disability Report (Form SSA-3820) to apply for Supplemental Security Income (SSI). 

If you apply for benefits online, you’ll complete the form and questions yourself. If you file in person at your local SSA office, an SSA claims representative can help walk you through the questions.

6 Tips for filling out Form SSA-3368

Before filling out the form, consider the following tips for success:

1. Review your disability application materials

Form SSA-3368 features questions about your work history, your conditions, and how they affect you. The Work History Report, Function Report, and main application form also cover those topics, in much greater detail. 

To ensure your application is consistent, you can use your answers from those forms as a guide. It is important to build a credible and clear case.

2. Gather your healthcare providers’ contact details before you start

You’ll need to share the contact information of your healthcare providers and medical professionals who’ve been involved in treating, diagnosing, or managing your condition. 

The SSA will contact these providers to request your medical records and to learn more about your disability from a third-party source. Take the time to make sure all this information is accurate and complete. Any incomplete or incorrect contact details will slow down — or completely halt — your application. 

3. Focus on your inability to work

Your responses to questions should focus on how your medical condition impacts your ability to carry out work responsibilities, not how your limitations impact your personal or social life. The SSA’s job is to assess if you’re physically or mentally capable of working. 

4. Fill in every section

It is essential to fill out every section of the Adult Disability Report. Leaving answers blank can delay your application or lead to outright rejection. If your form is missing information, the SSA or DDS might request the information, in which case you’ll have 10 days to respond. You also might receive a denial and have to restart the application process. 

You’ll be instructed to skip some parts of Form SSA-3368 if they don’t apply to you. In those cases, the directions will be very clear. You generally need to check a box indicating that you intentionally followed the instructions, rather than simply forgetting to fill out a question. Don't assume you can skip a part without seeing these instructions.

5. Give specific examples of your limitations

Include concrete examples in your responses. If you don’t give a clear explanation for your limitations, the SSA will assume you did the most demanding version of the activity. 

If a question asks you about your work capabilities, be specific about your limitations. For example, instead of saying “I had to quit because my arthritis worsened,” give an example: “I had to quit because my joint pain was too severe to use a pen or operate the cash register.”

6. Use the “Remarks” section for additional information.

You may need more space than allotted for your answers. Section 11 in the Adult Disability Form, labeled “Remarks,” is for any information you are unable to fit in previous sections. We include this line in the “Remarks,” just in case we missed anything: “All dates and figures are estimates based on my best recollection. Updated medical records and evidence will be provided as needed.”

How to fill out Form SSA-3368 section-by-section

Download the latest version of Form SSA-3368 from the SSA's website, or get a copy at your local SSA office. Before filling out the form, check out this overview of each section so you know what to expect:

Section 1 - Applicant contact information

Start the form by sharing your contact and communication details, including your name, address, phone number, and preferred language. 

Section 2 - Secondary contact information

In this section, list contact details for someone else who’s familiar with your disability (other than your doctors). If your application includes the Third-Party Function Report, the same person who completed it is a natural choice to list here. 

If someone other than you, you’ll list their contact information here, too. 

If you don’t have anyone in your life who is supportive of your application, it’s better to leave this blank.

Section 3 - Medical conditions

List the conditions that contribute to your disability. This section also includes basic physical questions about your height, weight, and shoe size. For consistency, list the same conditions as your main application form. 

Be sure to include all disabilities and health conditions that affect your ability to work and conditions diagnosed by a doctor. If you have more than you can list here, add them to the “Remarks” section. 

Section 4 - Work activity

Questions in this section cover your current work situation and how your condition affects your ability to work. Depending on your situation, you may not need to answer every question in this section. The section indicates which questions apply to you. 

Section 5 - Education and training

In addition to outlining your education and career training, you’ll answer simple questions about your language, reading, and writing abilities. 

Section 6 - Job history

In this section, you can list up to five jobs that you held in the last 5 years. If you have more than five jobs from the last 5 years, you can add them in the “Remarks” section.

If you held only one job during that period, you’ll answer follow-up questions about your job responsibilities for that role. If you have not worked in the past 5 years, check the appropriate box and skip ahead to the next section.

These job titles should match the government’s understanding of your work. For example, supervising and managing people are highly technical in government speak. But it’s also very common for job titles to include the word “manager” or “supervisor,” when they didn’t actually supervise other people. So be very clear about what your job actually was when filling out this section.

Your answers must be consistent across every form you submit, so it can be helpful to re-use the answers you’ve already shared elsewhere in the application. Job history information is part of the Work History Report and the main application form. 

Section 7 - Medicines

List all the prescription and non-prescription medications you take to manage your condition. You’ll also need to list the reason for taking each medication and the name of the prescribing doctor, if applicable. 

Only list medicines relevant to the conditions for which you’re applying. For example, if you need disability benefits because you have migraines and joint pain, do not list your diabetes medication.

An example of a prescription medication is Valium or Metformin, and a non-prescription medication might be an over-the-counter painkiller, like Advil. You can also include vitamins and supplements if part of your prescribed treatment plan.

This section corresponds to Question 22 of the Function Report. Before filling out this section, it can help to gather your medication containers to ensure the information you enter is accurate. 

 If you are not experiencing side effects right now, you can say “None to report at this time.”

Section 8 - Medical treatment 

In the following section, you will list all the treatments you’re receiving or are scheduled to receive in the future. 

You will also provide contact information for up to six healthcare providers who have either treated you in the past or are scheduled to do so in the future. In addition, you’ll share your treatment history with these providers.If there are more than six healthcare providers with relevant information about your condition, list them in the “Remarks” section.

For this section, you’ll need to list any outpatient appointments, emergency room visits, and hospital stays. Provide details for each, including the related condition and treatment. There’s also a checkbox list for medical tests.

Section 9 - Other medical information 

Here, you will list any professionals or organizations with knowledge of your medical history. This might include a social worker assigned to your case or an insurance agency who approved a claim related to your condition. Many people don’t have anyone to list here, and that’s okay.

Section 10 - Vocational rehabilitation, employment, or other support services

This section is only for applicants already receiving Supplementary Security Income (SSI). If you are an SSI recipient and have participated in any programs designed to help you return to work, such as skills training or job search assistance, you’ll include the program details here. 

Section 11 - Remarks

This final section is for any information throughout the form you were unable to fit in the allotted answer space. This section lets you include any details the form requests. However, it is important to include only the information explicitly asked for by the SSA.

We often include this line in the “Remarks,” just in case we missed anything: “All dates and figures are estimates based on my best recollection. Updated medical records and evidence will be provided as needed.”

Get help applying for Social Security disability

Applying for disability benefits is a complex process. A qualified disability lawyer can help ease the application process and improve your chances of winning benefits by three times.

Take our 2-minute disability quiz, and an Atticus team member will reach out for more information about your case and offer advice. If you’d like, we can match you with a disability attorney. There are no upfront costs to working with a lawyer — you only pay a fee after you win benefits.

The Bottom Line

The Adult Disability Report, called (Form SSA-3368-BK), is the required form adults must use to explain their medical conditions, treatments, limitations, and work history so Social Security can decide if they qualify for disability benefits. Set aside 90 minutes to fill out the form in the required level of detail.

Related resources:

How to Fill Out the Social Security Function Report (Form SSA-3373)

By Jackie Jakab

How to Fill out the Social Security Work History Report (Form SSA-3369)

By Jackie Jakab