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Form SSA-3373, Function Report - Adult, page 1
Complex · 72/100Form Complexity Index

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What this form asks for

The AI fills all of it, from your answers or your documents.

Form SSA-3373, officially known as the Function Report - Adult, is a document used by the Social Security Administration to assess how an individual's disabilities affect their daily activities and work capabilities. It is crucial for individuals applying for disability benefits, as it provides detailed information that helps determine eligibility and the extent of assistance needed.
Fillable fields197
Pages10
Sections68
Tables and lists1
Questions that depend on earlier answers51
Form Complexity IndexComplex, 72/100

The AI checks your answers before you download

15 checks built for this form, so a wrong date or a missing answer is caught before anyone else sees it.

Ensures that all sections of the form are completed without any blank answers, applying 'don't know', 'none', or 'does not apply' where necessary.

The AI software ensures that every section of Form SSA-3373 is fully completed, leaving no blank answers. It automatically applies responses such as 'don't know', 'none', or 'does not apply' in situations where the applicant may not have the information or the question is not relevant to their situation. This validation check is crucial for maintaining the integrity and completeness of the form, ensuring that all necessary information is provided for a thorough review. By doing so, it helps in avoiding delays in the processing of the application due to incomplete information.

Confirms that the form is printed or typed for clarity, adhering to the general guidelines provided.

The AI software confirms that Form SSA-3373 is either printed or typed, ensuring clarity and legibility throughout the document. This validation check adheres to the general guidelines provided by the Social Security Administration, which recommend typed or printed forms for easier reading and processing. By enforcing this standard, the software helps in reducing the likelihood of misinterpretation or errors that can arise from handwritten forms. This step is essential for maintaining a professional and accessible document for review.

Verifies that the 'REMARKS' section on Page 10 is utilized for additional information, with proper referencing to the question number.

The AI software verifies that the 'REMARKS' section on Page 10 of Form SSA-3373 is properly utilized for any additional information the applicant wishes to provide. It ensures that any entries in this section are correctly referenced to the corresponding question number, facilitating a clear and organized presentation of supplementary details. This validation check is important for capturing all relevant information that may not fit within the confines of the standard questions. It aids in providing a comprehensive overview of the applicant's situation, enhancing the review process.

Checks that Section A - General Information is fully completed, including full name, Social Security number, daytime telephone number, and details about the living situation.

The AI software checks that Section A - General Information of Form SSA-3373 is fully completed, ensuring that all required fields such as the full name, Social Security number, daytime telephone number, and details about the living situation are accurately filled out. This validation is critical for identifying the applicant and facilitating communication regarding their application. By confirming the completeness of this section, the software helps in establishing a clear and direct line of contact, as well as understanding the applicant's living conditions, which may impact the assessment of their case.

Validates that Section B - Information About Your Illnesses, Injuries, or Conditions thoroughly describes how conditions limit the ability to work.

The AI software validates that Section B - Information About Your Illnesses, Injuries, or Conditions of Form SSA-3373 thoroughly describes how the applicant's conditions limit their ability to work. This includes a detailed account of the symptoms, treatments, and the impact on daily activities and work capacity. Ensuring this section is comprehensively completed is vital for the Social Security Administration to assess the extent of the applicant's disabilities and their eligibility for benefits. This validation check plays a key role in providing a clear and detailed picture of the applicant's health challenges and their implications on employment.

Ensures that Section C - Information About Daily Activities accurately details the daily routine, care responsibilities, changes in abilities, and the impact of conditions on sleep and personal care.

The AI software ensures that Section C is thoroughly completed, capturing detailed information about the individual's daily activities. It verifies that the section accurately reflects the daily routine, including any care responsibilities the individual may have. Additionally, it checks for any changes in abilities due to conditions and how these conditions impact sleep and personal care. This comprehensive review ensures that the information provided is both accurate and relevant to the individual's situation.

And 9 more checks
  • Confirms that Section D - Information About Abilities correctly identifies affected items and provides explanations on how conditions impact abilities.
  • Verifies that Section E - Remarks includes any additional information not covered in previous sections, along with the name, date, and contact information of the person completing the form.
  • Checks that the form is reviewed for completeness and accuracy before submission, with the instruction sheet removed.
  • Ensures that comments about the form or the time it took to complete are sent to the provided address, not included with the completed form.
  • Validates that no assistance from a doctor or hospital was requested to complete the form, as per instructions.
  • Confirms that explanations are provided where necessary, especially for questions that ask for one or where an explanation could clarify the answer.
  • Verifies that activities performed with the help of others are indicated as required.
  • Checks that the form is submitted to the local Social Security office, following the final steps outlined in the instructions.
  • Ensures that the form is completed in a manner that is honest and thorough, reflecting the true impact of the individual's conditions on their daily life and abilities.

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How to Fill Out Form SSA-3373 Online for Free in 2026

What the AI walks you through.

  1. Visit instafill.ai and select Form SSA-3373.
  2. Enter personal and contact information.
  3. Detail illnesses, injuries, or conditions.
  4. Describe daily activities and limitations.
  5. Provide information on personal care and meals.
  6. List household chores and shopping habits.
  7. Sign and date the form electronically.
  8. Check for accuracy and submit the form.

Common Mistakes in Completing Form SSA-3373

The ones the AI is built to catch.

Leaving answers blank instead of writing 'does not apply'
A frequent oversight is leaving sections blank when they do not apply to the individual, rather than explicitly stating 'does not apply'. This can lead to delays in processing as it may be unclear whether the omission was intentional or an oversight. To avoid this, carefully review each question and provide a clear response, even if it's to indicate that a question does not pertain to your situation. This clarity helps ensure that your form is processed efficiently and without unnecessary requests for additional information.
Not providing detailed explanations where required
Applicants often fail to provide detailed explanations in sections that require a narrative description of their condition or limitations. This lack of detail can hinder the evaluation of the claim. It's crucial to be thorough and descriptive, explaining how your condition affects your daily activities and work capabilities. Providing specific examples and detailed accounts can significantly strengthen your application by offering a clearer picture of your situation.
Failing to indicate if activities are performed with help
Another common mistake is not specifying whether certain activities are performed with assistance. This information is vital for assessing the level of impairment and the need for support. Clearly indicate any activities that you cannot perform independently, detailing the nature of the assistance required. This includes both physical tasks and cognitive functions, ensuring a comprehensive understanding of your limitations and needs.
Incorrect or incomplete Social Security number
Providing an incorrect or incomplete Social Security number is a critical error that can lead to immediate rejection of the form. Double-check your Social Security number before submission to ensure accuracy. This number is essential for identifying your records and processing your application, so any discrepancy can cause significant delays or issues in the evaluation of your claim.
Omitting daytime telephone number in Section A
Failing to provide a daytime telephone number in Section A is a common oversight that can complicate communication regarding your application. Including a reliable contact number ensures that you can be reached for any clarifications or additional information needed. Make sure to provide a number where you are readily available during business hours, facilitating smoother and more efficient communication with the Social Security Administration.
Not thoroughly describing how conditions limit work ability
A frequent oversight is failing to provide a comprehensive account of how one's medical conditions limit their ability to work. This includes not detailing specific tasks that are difficult or impossible to perform due to the condition. To avoid this, individuals should take time to reflect on their daily work-related challenges and describe them in detail, including any accommodations they require or have tried. It's also beneficial to consult with a healthcare provider to ensure all relevant limitations are accurately documented.
Overlooking details about daily activities and changes
Applicants often neglect to fully describe their daily activities and any significant changes in their ability to perform these activities due to their condition. This oversight can lead to an incomplete understanding of the applicant's situation. To prevent this, it's crucial to meticulously document all daily activities, noting any modifications or assistance needed. Including specific examples and the frequency of these activities can provide a clearer picture of the applicant's daily challenges.
Not checking all items in Section D that conditions affect
Many individuals fail to check all applicable items in Section D that their conditions affect, leading to an incomplete assessment of their limitations. It's important to carefully review each item in this section and mark all that apply, even if the impact seems minor. This thoroughness ensures that the Social Security Administration has a complete understanding of how the condition affects various aspects of the individual's life. Consulting with a medical professional can also help identify all relevant impacts.
Forgetting to use the 'REMARKS' section for additional info
The 'REMARKS' section is often underutilized, with applicants failing to provide additional information that could support their case. This section is an opportunity to elaborate on any points that require further explanation or to include information not covered elsewhere in the form. To make the most of this section, applicants should review their responses and consider any additional details that could provide a fuller picture of their condition and its impact on their life. Including specific examples or recent changes in condition can be particularly helpful.
Submitting the form without removing the instruction sheet
A common procedural error is submitting the form without first removing the instruction sheet. This oversight can lead to unnecessary delays in processing. To avoid this, applicants should ensure that only the completed form and any required attachments are submitted. Double-checking the submission packet against the form's instructions can help prevent this mistake and facilitate a smoother review process.
Not reviewing responses for completeness and accuracy
Failing to thoroughly review the responses on Form SSA-3373 before submission can lead to incomplete or inaccurate information being provided to the Social Security Administration (SSA). This oversight can delay the processing of your application or result in a denial of benefits. It is crucial to double-check each section of the form to ensure all questions are answered fully and accurately. Taking the time to review your responses can significantly impact the outcome of your application.
Sending comments about the form to the wrong address
Incorrectly addressing comments or additional information related to Form SSA-3373 to the wrong SSA office can result in your feedback not being received or considered in your application process. Always verify the correct mailing address or submission method for any correspondence with the SSA. This ensures that your comments are properly received and can be taken into account during the review of your application. Properly addressing your correspondence is a simple yet effective way to avoid unnecessary delays.

Frequently Asked Questions About Form SSA-3373

 

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How does the AI fill out Form SSA-3373?
You answer a few questions in plain words, or upload a document you already have. The AI reads what you give it and puts each answer into the right field of Form SSA-3373, on every page, in seconds. It checks the answers against the form's own rules, and you review and change anything before you download, print or sign.
What happens to my information?
It is encrypted in transit and at rest, and it is never used to train AI.
How complex is Form SSA-3373 to fill out?
Form SSA-3373 has a Form Complexity Index of 72 out of 100, in the complex tier: 197 fillable fields across 10 pages. Instafill.ai's AI fills it in under a minute, with every field there for you to review before you download.
What is the purpose of Form SSA-3373, Function Report - Adult?
The purpose of Form SSA-3373, Function Report - Adult, is to collect detailed information about how an individual's illnesses, injuries, or conditions affect their ability to perform daily activities and work. This information is used by the Social Security Administration (SSA) to assess the individual's eligibility for disability benefits.
Who should complete Form SSA-3373?
Form SSA-3373 should be completed by an adult who is applying for disability benefits through the Social Security Administration (SSA). It is designed to be filled out by the individual themselves, as it requires personal insights into how their conditions affect their daily life and work capabilities.
What information is required in Section A - General Information of Form SSA-3373?
Section A - General Information of Form SSA-3373 requires basic personal details about the individual, including their name, Social Security number, and contact information. It also asks for information about the individual's medical conditions, the healthcare providers they have seen, and any medications they are taking.
How do I describe how my illnesses, injuries, or conditions limit my ability to work on Form SSA-3373?
To describe how your illnesses, injuries, or conditions limit your ability to work on Form SSA-3373, you should provide detailed information about the specific tasks and activities you find difficult or are unable to perform due to your condition. Include any physical, mental, or emotional limitations, and describe how these limitations affect your ability to perform your job or any other work-related activities.
What should I include when describing my daily activities on Form SSA-3373?
When describing your daily activities on Form SSA-3373, include detailed information about your routine tasks and how your conditions affect your ability to perform them. This can include personal care, household chores, social activities, and any other daily tasks. Be specific about any difficulties you encounter, such as pain, fatigue, or the need for assistance, and how these challenges impact your daily life.
How do I report changes in my ability to perform personal care tasks on Form SSA-3373?
To report changes in your ability to perform personal care tasks on Form SSA-3373, you should provide detailed information about any difficulties or changes you experience in activities such as bathing, dressing, grooming, and using the toilet. Be specific about the nature of the changes, how often they occur, and any assistance or adaptive equipment you require.
What details should I provide about my meal preparation habits on Form SSA-3373?
When detailing your meal preparation habits on Form SSA-3373, include information about your ability to plan, prepare, and cook meals. Mention any difficulties you face, such as standing for long periods, using kitchen appliances, or following recipes. Also, note if you require assistance or special equipment to prepare meals.
How do I list household chores and yard work I am able to do on Form SSA-3373?
On Form SSA-3373, list the household chores and yard work you are able to perform, specifying the frequency and duration of these activities. Include any limitations or difficulties you experience, such as pain, fatigue, or the need for breaks. If you use any assistive devices or require help from others, make sure to mention this as well.
What information is needed about my shopping habits on Form SSA-3373?
Regarding your shopping habits on Form SSA-3373, provide details about your ability to shop for groceries, clothing, and other necessities. Include information on how you get to the store, your ability to navigate the store, carry items, and manage payments. Mention any assistance you require or any difficulties you encounter during shopping.
How do I describe my ability to get around and travel on Form SSA-3373?
To describe your ability to get around and travel on Form SSA-3373, detail your mobility both inside and outside your home. Include information on your ability to walk, use public transportation, drive, or travel alone. Mention any aids you use, such as canes, walkers, or wheelchairs, and any difficulties you face, including pain, fatigue, or the need for assistance.
What should I include about my ability to handle money on Form SSA-3373?
On Form SSA-3373, you should provide detailed information about your ability to handle money, including any difficulties you face in managing your finances due to your illnesses, injuries, or conditions. Mention if you need assistance from others to pay bills, manage a bank account, or make financial decisions. It's important to be specific about the nature of your limitations and how they impact your daily financial activities.
How do I report my hobbies and interests on Form SSA-3373?
When reporting your hobbies and interests on Form SSA-3373, describe the activities you enjoy and how often you engage in them. Be sure to mention any changes in your ability to participate in these activities due to your illnesses, injuries, or conditions. If you have had to give up any hobbies or interests because of your health, include this information as well. This helps provide a comprehensive view of how your conditions affect your daily life.
What details should I provide about my social activities on Form SSA-3373?
On Form SSA-3373, you should provide details about your social activities, including how often you engage in social interactions, the types of social activities you participate in, and any difficulties you experience due to your illnesses, injuries, or conditions. Mention if you require assistance or accommodations to participate in social events, and describe any changes in your social life since your conditions began. This information helps to illustrate the impact of your conditions on your ability to interact with others.
How do I describe how my illnesses, injuries, or conditions affect my abilities on Form SSA-3373?
To describe how your illnesses, injuries, or conditions affect your abilities on Form SSA-3373, provide detailed information about the specific limitations you experience in your daily activities. Include examples of tasks that are difficult or impossible for you to perform, such as walking, standing, lifting, concentrating, or completing household chores. Be specific about the severity of your limitations and how they impact your ability to work and perform daily activities. This detailed description helps the Social Security Administration understand the extent of your impairments.
What should I include about the use of aids and devices on Form SSA-3373?
On Form SSA-3373, you should include information about any aids or devices you use to assist with your daily activities due to your illnesses, injuries, or conditions. This can include items such as canes, walkers, wheelchairs, hearing aids, or special software for computers. Describe how often you use these aids, how they help you, and any limitations you still experience despite their use. This information helps to provide a complete picture of your functional abilities and the extent of your impairments.
How do I report the medicines I take and their side effects on Form SSA-3373?
On Form SSA-3373, you should list all the medicines you are currently taking, including the name of the medicine, the dosage, how often you take it, and the reason you are taking it. Additionally, you should describe any side effects you experience from these medicines in the section provided for this purpose. Be as detailed as possible to ensure the Social Security Administration (SSA) has a complete understanding of how your medications affect your daily functioning.
What is the 'Remarks' section for on Form SSA-3373?
The 'Remarks' section on Form SSA-3373 is provided for you to include any additional information that you believe is important for the SSA to consider regarding your condition and how it affects your ability to work. This can include details about your daily activities, any changes in your condition, or any other information that was not covered in the other sections of the form.
How can I get help completing Form SSA-3373?
If you need help completing Form SSA-3373, you can contact the Social Security Administration directly for assistance. They can provide guidance over the phone or in person at a local SSA office. Additionally, you may seek help from a legal representative, a social worker, or a trusted individual who is familiar with your medical condition and the SSA's requirements.
What are the consequences of providing false information on Form SSA-3373?
Providing false information on Form SSA-3373 can have serious consequences, including the denial of your Social Security Disability benefits. If the SSA discovers that you have provided false information, they may also take legal action against you for fraud. It is important to be honest and accurate when completing the form to avoid these potential consequences.
Where should I send the completed Form SSA-3373?
Once you have completed Form SSA-3373, you should send it to the Social Security Administration office that requested the form. If you are unsure of where to send it, you can contact the SSA directly for the correct mailing address. It is important to send the form to the correct office to ensure it is processed in a timely manner.
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