Form SSA-3373-BK is the Social Security Administration’s Function Report – Adult, and you fill it out by giving honest, detailed, and consistent answers about how your medical conditions limit your daily activities, personal care, and ability to work. The form is one of the most important pieces of evidence in your disability claim, because it gives the Disability Determination Services examiner and any later Administrative Law Judge a window into your typical day, not your best day.
The form exists because the Social Security Administration must follow the five-step sequential evaluation process under 20 C.F.R. § 404.1520, and steps four and five require the agency to measure your Residual Functional Capacity (RFC). Your answers on the SSA-3373-BK directly shape that RFC, and a vague or inconsistent form can sink an otherwise strong claim. According to the SSA’s Annual Statistical Report on the Disability Insurance Program, only about 35% of initial SSDI claims are approved, and weak Function Reports are a leading reason for denial.
This guide walks you through every section, line by line, with named examples and the federal rules that govern each answer. It is written for first-time claimants, caregivers, paralegals, and disability advocates alike.
Here is what you will learn:
- 📝 How to answer every line of Form SSA-3373-BK without hurting your claim
- ⚖️ Which federal regulations and Social Security Rulings control how examiners read your answers
- 👥 Real named examples for musculoskeletal, mental health, cognitive, and autoimmune impairments
- 🚫 The seven biggest mistakes that destroy credibility under SSR 16-3p
- 💡 How to align your Function Report with medical records, third-party statements, and the RFC standard
What Form SSA-3373-BK Is and Why It Exists
The SSA-3373-BK is a 10-page self-report questionnaire mailed to most adult claimants after they file for Social Security Disability Insurance (SSDI) under Title II or Supplemental Security Income (SSI) under Title XVI. The form asks about your daily activities, personal care, social functioning, and physical and mental abilities. Disability Determination Services uses your answers, along with your medical records, to decide whether your impairments meet a Listing of Impairments or reduce your RFC enough to prevent work.
The legal foundation for the form sits in 20 C.F.R. § 404.1512, which requires you to provide evidence of your impairments, and in 20 C.F.R. § 404.1529, which tells the agency how to evaluate your symptoms. The plain-English meaning is simple: you must tell the SSA how your conditions limit you, in your own words. The consequence of skipping the form or returning it blank is severe, because the agency can deny your claim for failure to cooperate under 20 C.F.R. § 404.1516.
Imagine Maria, a 47-year-old former warehouse worker with degenerative disc disease. She returns the form with one-word answers like “yes” and “no.” Her examiner has no way to picture her day, so the RFC defaults to a light work finding and her claim is denied at step five. A common misconception is that the medical records alone will speak for you. They will not, because the POMS DI 22510.005 instructs examiners to weigh function evidence from the claimant directly.
Who Receives the Form
The SSA mails the SSA-3373-BK to nearly every adult claimant within 30 days of filing. Some claimants receive a similar form called the SSA-3373 when filing online, and minors receive the SSA-3375-BK instead. If a third party helps you, they may also be asked to submit a Function Report – Adult – Third Party (SSA-3380-BK), which the examiner cross-checks against your answers.
The consequence of ignoring the mailing is automatic, because failing to return the form within the deadline (usually 10 days) triggers a denial for insufficient evidence under 20 C.F.R. § 416.916. A real example is James, a veteran with PTSD who set the envelope aside for three weeks. His claim was denied, and he had to start over with a new application, losing months of back pay.
How Examiners Read Your Answers
Examiners apply SSR 16-3p, which replaced the older “credibility” standard with a consistency analysis. They compare your Function Report to your medical records, your work history on the SSA-3369-BK, and any third-party statements. The plain-English rule is that your answers must line up with the rest of the file.
A common misconception is that exaggerating limitations helps. It does not, because under SSR 16-3p any inconsistency, even a small one, gives the examiner a reason to discount your statements entirely. The consequence is a denial at the initial level and an uphill battle at the Administrative Law Judge hearing.
Section-by-Section Walkthrough of Form SSA-3373-BK
The form is divided into ten major sections, each with its own purpose and pitfalls. The walkthrough below covers every line item, with the governing rule, the consequence of a sloppy answer, a named example, and a misconception to clear up.
Section A: Information About You
This section asks for your name, Social Security number, date of birth, height, weight, and who is filling out the form. The plain-English rule is to be precise, because errors here can delay processing. The consequence of a typo in your SSN is a routing error inside the National 800 Number Network, which can stall your claim for weeks.
If someone else completes the form for you, write their name and relationship and explain why they are helping. A real example is Linda, a 62-year-old with severe rheumatoid arthritis whose daughter completed the form because Linda could not grip a pen. Linda noted this clearly in Section A, which strengthened her later credibility on hand-use limitations. A misconception is that having help looks weak; in fact, it documents a real limitation.
Section B: Information About Your Illnesses, Injuries, or Conditions
Question 4 asks how your conditions limit your ability to work. Do not list diagnoses; list functional limits. The governing rule is 20 C.F.R. § 404.1545, which defines RFC as what you can still do despite your limitations.
For example, Maria should write, “I cannot lift more than 5 pounds, cannot stand more than 10 minutes, and cannot sit more than 20 minutes without changing position.” She should not write, “I have degenerative disc disease.” The consequence of listing only diagnoses is a vague RFC, because the examiner cannot translate “DDD” into work-related limits. A common misconception is that more medical jargon helps; in reality, the POMS DI 24510.005 tells examiners to focus on function, not labels.
Section C: Information About Your Daily Activities
Question 5 asks you to describe a typical day from waking to sleeping. The plain-English rule is to be specific about time, frequency, and assistance needed. The governing standard is SSR 96-8p, which requires a function-by-function RFC assessment.
Write something like, “I wake at 7 a.m., need 30 minutes to get out of bed because of stiffness, take medication, eat cereal my husband prepares, lie down at 9 a.m. for an hour, watch TV, lie down again at noon, and go to bed at 8 p.m.” The consequence of writing “I watch TV all day” is a finding that you can perform sedentary work, because the examiner has no evidence of why you cannot sit at a desk. A misconception is that listing “rest” once is enough; you must show frequency and duration of breaks.
Section D: Personal Care
Questions 6–8 cover dressing, bathing, hair care, shaving, feeding yourself, using the toilet, and other self-care tasks. The governing rule is 20 C.F.R. § 404.1572, which distinguishes activities of daily living from substantial gainful activity. Be honest about what you avoid, modify, or skip.
A real example is David, a 55-year-old with major depressive disorder who showers only twice a week because of low motivation and energy. He should write that plainly, because hygiene avoidance is a recognized symptom under Listing 12.04. The consequence of writing “I shower daily” when you do not is a credibility hit under SSR 16-3p. A misconception is that admitting poor hygiene is shameful; for SSA purposes, it is medical evidence.
Section E: Meals
Question 9 asks who prepares your meals, what kinds, how often, and how long it takes. The plain-English rule is to compare before and after your impairment. The governing standard ties to SSR 96-9p, which addresses the erosion of the unskilled sedentary occupational base.
For example, Linda used to cook full dinners but now microwaves frozen meals because she cannot stand at the stove. She should write, “Before my illness, I cooked from scratch 5 nights a week. Now I microwave frozen meals once a day, and my husband cooks the rest.” The consequence of writing “I cook” without context is a finding that you can stand and use your hands well enough for light work. A misconception is that microwaving counts as cooking in the SSA’s eyes; the examiner reads it as a significant decline in function.
Section F: House and Yard Work
Question 11 asks what chores you do, how long they take, and how often. Question 12 asks why you do not do certain chores. Write specifically: “I sweep for 5 minutes, then must sit for 20 minutes.” The governing rule remains 20 C.F.R. § 404.1545, because chore tolerance is direct evidence of standing, walking, lifting, and reaching capacity.
A real example is James with PTSD, who cannot mow the lawn because the noise of the mower triggers flashbacks. He should write that, because Listing 12.15 recognizes trauma triggers. The consequence of leaving Question 12 blank is a presumption that you choose not to do chores, not that you cannot. A misconception is that doing any chores hurts your claim; in fact, limited and assisted chores help, because they show honesty.
Section G: Getting Around
Questions 13–17 cover going outside, transportation, driving, and traveling alone. The plain-English rule is to explain why you do not go out, not just that you do not. The governing rule is 20 C.F.R. § 404.1545(d), which covers nonexertional limits like concentration and social functioning.
For example, David writes, “I leave home only for medical appointments, about twice a month, and my sister drives me because my anxiety prevents driving on highways.” The consequence of writing “I drive” without limits is a finding that you can sustain concentration, persistence, and pace, which defeats most mental impairment claims. A misconception is that driving locally is the same as driving for work; under SSR 85-15, short local trips do not equal sustained work-day functioning.
Section H: Shopping
Question 18 asks what you shop for, how, how often, and how long. Be specific: “I shop online for groceries weekly because I cannot push a cart.” The governing rule again ties to RFC under § 404.1545.
A real example is Maria, who used to shop weekly at Costco but now uses Instacart because pushing a cart causes severe back spasms. She should write that. The consequence of writing “I shop weekly” without detail is a finding that you can walk and lift enough for light work. A misconception is that online shopping does not count as shopping; for SSA purposes, it shows a modified activity, which supports your claim.
Section I: Money
Questions 19–20 ask if you can pay bills, count change, handle a savings account, and use a checkbook. The plain-English rule is to explain cognitive or focus limits honestly. The governing standard is the Paragraph B criteria for mental listings, which include understanding, remembering, or applying information.
For example, David writes, “My wife pays all the bills because I forget due dates and have made costly mistakes.” The consequence of writing “I pay my own bills” when you struggle is a finding of no significant limit in cognitive functioning, which kills mental impairment claims. A misconception is that admitting money problems looks irresponsible; for the SSA, it is direct evidence of a Paragraph B limitation.
Section J: Hobbies and Interests
Question 21 asks what you do for fun, how often, and how well compared to before. Compare honestly. The governing rule remains SSR 16-3p consistency.
A real example is Linda, who used to garden three hours a day but now reads for 15 minutes before her hands cramp. She writes that. The consequence of writing “I read books” without before/after context is a finding that you can sit and concentrate for full work shifts. A misconception is that any hobby destroys your claim; the decline in hobbies is what matters most.
Section K: Social Activities
Questions 22–25 cover spending time with others, places you go, problems getting along, and changes in social activities. The plain-English rule is to describe frequency, duration, and conflict. The governing standard is the Paragraph B criterion for interacting with others.
For example, James writes, “Before PTSD, I went to family dinners weekly. Now I see family once every two months and leave early because crowds trigger panic.” The consequence of writing “I see family” without frequency is a finding of normal social functioning. A misconception is that texting friends counts as social activity; under SSR 16-3p, passive contact does not equal sustained interaction.
Section L: Abilities
Question 20 (the second numbering) gives 20 boxes covering lifting, squatting, bending, standing, reaching, walking, sitting, kneeling, talking, hearing, stair climbing, seeing, memory, completing tasks, concentration, understanding, following instructions, using hands, getting along with others, and other. Check every box that applies, then explain.
The governing rule is 20 C.F.R. § 404.1545(b)–(d), which lists exertional, nonexertional, and mental limits. For example, Maria checks lifting, squatting, bending, standing, reaching, walking, sitting, kneeling, stair climbing, completing tasks, and concentration, then writes specific limits beside each. The consequence of checking only one or two boxes is an artificially narrow RFC. A misconception is that checking many boxes looks exaggerated; if your records support each, it is thorough, not exaggerated.
Section M: Information About Abilities
Questions 21–22 (second numbering) ask how far you can walk, how long you can pay attention, whether you finish what you start, how well you follow written and spoken instructions, how you handle stress and changes in routine, and unusual fears. Be specific in minutes, feet, and percentages.
For example, David writes, “I can pay attention 10 minutes before my mind wanders. I finish about 1 in 4 tasks I start.” The consequence of vague answers like “not long” is an examiner default to no significant limit. A misconception is that “I can walk a block” is enough; the SSA needs feet and time, because SSR 96-9p ties walking distance to occupational base erosion.
Section N: Remarks
The Remarks section is your closing argument. Use it to add anything that did not fit, including bad days vs. good days, side effects of medications under SSR 96-7p, and the variability of symptoms.
A real example is Linda, who writes, “On bad days, which happen 3–4 days a week, I cannot get out of bed. On good days, I can sit and read for 30 minutes.” The consequence of leaving Remarks blank is a missed chance to explain variability, which is critical under Bjornson v. Astrue, 671 F.3d 640 (7th Cir. 2012), where the court held that “good days” do not equal work capacity. A misconception is that Remarks is optional; in practice, it is the most read section.
Three Common Scenarios and Their Outcomes
The tables below show how three real claimants’ answers shaped their decisions. Use them as a roadmap for your own answers.
Scenario 1: Musculoskeletal Claimant
| Answer Given | Examiner’s Outcome |
|---|---|
| “I can lift 5 lbs, stand 10 min, sit 20 min before changing position” | RFC limited to less than sedentary; favorable |
| “I do laundry but my husband carries the basket” | Confirms lifting limit; supports RFC |
| “I cook only microwave meals; cannot stand at stove” | Supports standing limit; consistent with records |
Scenario 2: Mental Health Claimant
| Answer Given | Examiner’s Outcome |
|---|---|
| “I shower twice a week due to no motivation” | Supports Paragraph B adapt and manage oneself limit |
| “Wife pays all bills; I forget due dates” | Supports understand, remember, apply limit |
| “I see family once every 2 months and leave early” | Supports interacting with others limit |
Scenario 3: Autoimmune Claimant
| Answer Given | Examiner’s Outcome |
|---|---|
| “Bad days 3–4x weekly; cannot get out of bed” | Supports off-task and absenteeism limits |
| “Daughter fills out form because I cannot grip pen” | Supports manipulative limit under Listing 14.09 |
| “Garden 15 min vs. 3 hrs before illness” | Documents functional decline; consistent |
Mistakes to Avoid on Form SSA-3373-BK
The following errors appear in the POMS DI 22510 as common reasons for credibility findings against claimants. Each mistake below carries a real consequence.
- Writing one-word answers. Yes/no answers tell the examiner nothing, and the consequence is a default RFC of light work under 20 C.F.R. § 404.1567.
- Listing diagnoses instead of limits. “I have lupus” tells the examiner nothing about function, and the consequence is a vague RFC.
- Describing only your worst day. Under SSR 16-3p, the agency wants a typical day, and overstating leads to inconsistency findings.
- Describing only your best day. Under Bjornson v. Astrue, the SSA cannot use good days to deny benefits, but you must say so.
- Leaving Remarks blank. You lose your closing argument, and the examiner may miss medication side effects.
- Contradicting your medical records. If your doctor noted you can lift 10 lbs and you write 50 lbs, the file is inconsistent and credibility tanks.
- Failing to explain why you cannot do an activity. “I do not drive” is weak; “I do not drive because of seizures” is strong.
- Returning the form late. Under 20 C.F.R. § 416.916, late returns can mean denial for failure to cooperate.
- Not checking enough ability boxes. An incomplete Section L produces an artificially favorable RFC for the SSA.
- Letting someone else answer without saying so. The form requires disclosure, and undisclosed help damages credibility.
Do’s and Don’ts of the Function Report
Each do and don’t below carries a why tied to the federal rules.
Do’s
- Do describe your typical day, because SSR 16-3p measures consistency over time.
- Do quantify limits in minutes, feet, and pounds, because RFC under § 404.1545 is measured that way.
- Do explain variability between good and bad days, because Bjornson v. Astrue controls how variability is read.
- Do list medication side effects in Remarks, because SSR 96-7p requires the agency to consider them.
- Do keep a copy before mailing, because you will need it for any appeal or ALJ hearing.
Don’ts
- Don’t exaggerate, because any inconsistency under SSR 16-3p discounts your entire statement.
- Don’t minimize, because Social Security cannot guess at limits you do not describe.
- Don’t use medical jargon, because POMS DI 24510.005 tells examiners to read for function, not labels.
- Don’t leave any question blank, because blanks are read as “no limitation” by default.
- Don’t mail the form without proof of mailing, because the SSA occasionally loses paperwork inside its field office workflow.
Pros and Cons of Filling It Out Yourself
Pros
- You know your daily life best, which helps describe limits accurately.
- You save the cost of a representative for this single step, though many NOSSCR-listed attorneys work on contingency.
- You begin a paper trail that shows your own voice, which can be valuable later at an ALJ hearing.
- You can take your time over a few days, which a busy attorney may not.
- You learn the form, which helps if SSA sends a follow-up SSA-454-BK Continuing Disability Review later.
Cons
- You may miss the legal weight of certain phrases, which a lawyer would catch.
- You may understate limits because of pride, which hurts credibility.
- You may overstate limits without realizing it contradicts your records.
- You may forget to mention side effects, which are critical under SSR 96-7p.
- You may miss the deadline, which leads to denial under § 416.916.
How the Form Interacts With the Rest of Your Claim
The Function Report does not stand alone. It is read alongside your Disability Report – Adult (SSA-3368-BK), your Work History Report (SSA-3369-BK), the third-party SSA-3380-BK, and all of your medical records. The plain-English rule is that every form must tell the same story.
The consequence of inconsistency across forms is severe, because under HALLEX I-2-6-58, the ALJ must explore each inconsistency at hearing. A real example is Maria, whose Function Report said she could lift 5 lbs but whose Work History Report said she lifted 25 lbs at her last job after her injury. The ALJ used that gap to discount her testimony, and her claim was denied.
A common misconception is that the SSA will ignore small contradictions. It will not, because SSR 16-3p instructs adjudicators to weigh consistency across the entire record. Cross-check your forms before mailing.
Role of Third-Party Function Reports
The SSA-3380-BK is given to a friend, family member, or caregiver who knows you well. The plain-English rule is that the third party should describe what they observe, not what they think the SSA wants to hear.
The consequence of a third-party report that contradicts yours is severe credibility damage. A real example is David, whose wife wrote that he “does fine around the house,” contradicting his own description of severe depression. The ALJ used the discrepancy to deny benefits. A misconception is that a glowing third-party report helps; in fact, an honest report that mirrors your own helps far more.
Role of Medical Source Statements
A Medical Source Statement (MSS) from your treating doctor carries great weight under 20 C.F.R. § 404.1520c for claims filed on or after March 27, 2017. Your Function Report should align with the MSS in lifting limits, sitting limits, and off-task percentages.
The consequence of misalignment is that the examiner may discount both documents. A misconception is that doctors’ opinions are automatically controlling; under § 404.1520c, the agency weighs supportability and consistency, not authority alone.
State Nuances and Federal-State Interplay
Although the SSA-3373-BK is a federal form, it is processed by your state’s Disability Determination Services. Each state has slight differences in turnaround time, examiner training, and consultative-exam scheduling. The plain-English rule is that you mail it to the address on the cover letter, not to your local SSA field office.
The consequence of mailing it to the wrong place is a delay of two to six weeks. A real example: in California’s DDS, the average wait for an initial decision in 2024 was 230 days, while Texas DDS averaged 215 days, per the SSA’s FOIA-released processing data. A misconception is that filing in a “fast” state helps; jurisdiction is set by your residence, not your choice.
State workers’ compensation and short-term disability decisions also matter, because under 20 C.F.R. § 404.1504, other agency findings are not binding but are still evidence. Mention any state ruling on your Function Report Remarks.
Key Court Rulings That Shape How Your Form Is Read
Three federal cases shape how courts review Function Report answers, and knowing them helps you write better answers.
In Bjornson v. Astrue, 671 F.3d 640 (7th Cir. 2012), the Seventh Circuit held that an ability to do limited daily activities does not equal an ability to sustain full-time work. The plain-English rule is that part-time, slow, assisted activity is not work capacity.
In Reddick v. Chater, 157 F.3d 715 (9th Cir. 1998), the Ninth Circuit held that the SSA cannot mischaracterize a claimant’s testimony to deny benefits. The consequence is that if you write something specific, the agency cannot pretend you said something broader.
In Sims v. Apfel, 530 U.S. 103 (2000), the Supreme Court held that claimants do not waive issues by failing to raise them at the Appeals Council. The misconception is that you must perfectly preserve everything; you do not, but a clear Function Report still saves time and money.
FAQs
Do I have to fill out Form SSA-3373-BK myself?
No. A friend, relative, caregiver, or representative may help, but you must sign it and disclose who assisted in Section A so the examiner can weigh the report properly under SSR 16-3p.
Will the SSA deny me if I return the form late?
Yes. Under 20 C.F.R. § 416.916, the SSA can deny a claim for failure to cooperate if you miss the deadline, usually 10 days from the cover letter date.
Should I exaggerate my limits to improve my chances?
No. Exaggeration creates inconsistencies with your medical records, and under SSR 16-3p any inconsistency lets the adjudicator discount your entire statement.
Does the SSA verify what I write?
Yes. Examiners cross-check your Function Report against medical records, the SSA-3369-BK Work History Report, and any third-party SSA-3380-BK before deciding.
Is the Function Report used at the hearing level too?
Yes. The Administrative Law Judge reads your original Function Report, and inconsistencies between it and your hearing testimony will be explored under HALLEX I-2-6-58.
Do I need to fill it out again if I appeal?
Yes. On reconsideration and at the hearing level, the SSA usually sends a fresh SSA-3373-BK so it can capture any worsening or improvement in your condition.
Will mentioning hobbies hurt my claim?
No. Honest hobby descriptions that show decline and modification actually help, because they document functional loss without raising credibility flags.
Should I list every medication side effect?
Yes. Side effects like drowsiness, dizziness, or nausea are weighed under SSR 96-7p and can support an off-task or absenteeism RFC limit.
Can a third-party report alone win my case?
No. A third-party SSA-3380-BK supports your claim but cannot replace your own Function Report or your medical evidence under 20 C.F.R. § 404.1513.
Does it matter if I type or handwrite the form?
No. The SSA accepts both, but typed answers are easier to read, and you can also complete the online iAppeals system for many claims.
Will hiring an attorney to help with the form cost extra?
No. Most SSDI/SSI attorneys work on contingency under 42 U.S.C. § 406, capped at 25% of back pay or $9,200 (2025 cap), and form help is included.
Can I attach extra pages if the form runs out of room?
Yes. You may attach additional sheets labeled with your name, SSN, and the question number, and the examiner is required to read every attached page under POMS DI 22505.001.
Related reading
- How to Fill Out Form SSA-3369-BK (w/Examples) + FAQs
- How to Fill Out Form SSA-3376-BK (w/Examples) + FAQs
- How to Fill Out Form SSA-3378-BK (w/Examples) + FAQs
- How to Fill Out Form SSA-3380-BK (w/Examples) + FAQs
- How to Fill Out Form SSA-7157-F4 (w/Examples) + FAQs
- How to Fill Out Form SSA-3377-BK (w/Examples) + FAQs
- How to Fill Out Form SSA-8001-BK (w/Examples) + FAQs