How to Fill Out Form SSA-3380-BK (w/Examples) + FAQs

You fill out Form SSA-3380-BK, the Function Report – Adult, by describing how your medical conditions limit your daily life in clear, honest, and detailed sentences that match your medical records. The Social Security Administration uses your answers to decide if your impairments stop you from working, so vague replies like “I can’t do much” can sink an otherwise strong claim. Every section asks about a specific area of function, and each blank line is a chance to prove or weaken your case.

The Function Report is governed by 20 C.F.R. § 404.1512, which makes you responsible for giving evidence of your disability, and 20 C.F.R. § 404.1529, which tells adjudicators how to weigh your symptoms. The agency also follows SSR 16-3p for evaluating your credibility and POMS DI 22510 for developing your activities of daily living. If you ignore these rules, your claim can be denied for “insufficient evidence,” even when your medical file shows a serious condition.

Roughly 65% of initial disability claims are denied at the first level, according to recent figures published by the SSA Annual Statistical Report, and a poorly completed Function Report is a leading reason. Here is what you will learn in this guide:

• 📝 How to answer every line of Form SSA-3380-BK with the right level of detail
• ⚖️ Which federal rules and rulings shape how your answers are scored
• 🧑‍⚕️ How to align your answers with your medical records and treating sources
• 🚫 The most common mistakes that trigger denials and appeals
• 💡 Real examples, scenarios, dos and don’ts, and FAQs to guide your draft

What Form SSA-3380-BK Is and Why It Matters

Form SSA-3380-BK is the Adult Function Report that the Social Security Administration sends after you file for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). The form asks about your day, your chores, your hobbies, your social life, and your physical and mental limits. It is not a medical form, but the answers act like sworn testimony about how your conditions affect real life.

The form lands in your mailbox after the state Disability Determination Services (DDS) office gets your file. A claims examiner pairs your answers with your medical records, work history, and any third-party reports. If your answers conflict with your records, the examiner can find you “not fully credible” under SSR 16-3p, and that finding alone can cost you the case.

The deadline to return the form is usually 10 days from the date on the cover letter, though extensions are common if you call. Missing the deadline can lead to a technical denial under POMS DI 23007.005, which means your claim is closed without a medical decision. The consequence is a forced restart of your case and months of lost back pay.

A common misconception is that the Function Report is a casual survey. In truth, courts treat it as substantive evidence, and federal judges quote it back to claimants during hearings. Treat every line as if a judge will read it out loud.

The Legal Backbone of the Function Report

Three federal rules drive how your Function Report is scored. First, 20 C.F.R. § 404.1545 defines your residual functional capacity (RFC), the most you can still do despite your limits. Your Function Report feeds the RFC directly.

Second, SSR 16-3p replaced the old “credibility” standard with a symptom evaluation standard, meaning the examiner must compare your statements with the objective record. If your form says you walk a half-mile each day, but your doctor’s notes say you use a cane, the examiner will discount your symptom claims. The consequence is a higher RFC and a likely denial at Steps 4 and 5 of the sequential evaluation.

Third, POMS DI 22510 instructs examiners to develop ADLs (activities of daily living) “in the claimant’s own words.” That is why the form has so many blank lines instead of checkboxes. A common misconception is that short answers are safer; the opposite is true, because short answers leave the examiner free to assume you have no limits.

Who Sends and Who Reads the Form

The form comes from your state DDS, not from the federal SSA office. A real example: Maria Lopez, a claimant in Sacramento, files online at ssa.gov/applyfordisability, and four weeks later she gets the SSA-3380-BK from California DDS. Her examiner, not a doctor, reads her answers first.

If your claim moves to a hearing, an Administrative Law Judge (ALJ) and a vocational expert will both read the form. The ALJ may ask you to explain a sentence word for word. The consequence of sloppy answers is a hearing transcript that hurts your case on appeal to the Appeals Council or federal district court.

Before You Start: Gather These Documents

You should not start writing until you have your medical records, medication list, and a daily journal in front of you. The form has limited space, so you must pick the strongest, most specific facts. Pulling records also helps you avoid the trap of contradicting your own doctors.

Pull your last 12 months of treatment notes from your treating physician, specialists, therapists, and any hospital visits. Add a current medication list with dosages and side effects, because Section E asks about them in detail. Keep a one-week diary of your sleep, pain levels, and chores so you can write in concrete terms instead of guesses.

A real example: James Carter, a former warehouse worker with chronic back pain, spent two evenings reading his MRI report and physical therapy notes before drafting. He matched each limit on the form to a phrase in his records, like “cannot stand more than 15 minutes.” His examiner approved the claim at the initial level, which is rare. The consequence of skipping this step is a Function Report full of generalities, which courts have repeatedly called “self-serving” in cases like the Seventh Circuit’s discussion of credibility in Bjornson v. Astrue.

Section-by-Section Walkthrough of SSA-3380-BK

The form has Sections A through I, plus a “Remarks” page. Each section has a purpose, and each blank line is scored. Below is a deep look at every section, with the right level of detail and the consequences of each choice.

Section A: General Information

Section A asks for your name, Social Security number, and an open-ended question: “How do your illnesses, injuries, or conditions limit your ability to work?” This is your thesis statement. List every condition, even ones that seem minor, because 20 C.F.R. § 404.1523 requires the agency to consider the combined effect of all impairments.

Write in plain sentences, not medical jargon. For example, instead of “L4-L5 radiculopathy,” write “nerve pain that shoots down my left leg when I stand more than 10 minutes.” The consequence of jargon is that the examiner may miss the functional impact, even if the diagnosis is severe.

A common misconception is that you should list only your “main” condition. The agency must analyze every medically determinable impairment, so leaving out depression or sleep apnea can shrink your RFC analysis. Be thorough.

Section B: Information About Your Daily Activities

This section starts with “Describe what you do from the time you wake up until going to bed.” Write a full day in chronological order, including breaks, naps, and bad-day patterns. Mention who helps you, what you skip, and how long each task takes.

The agency uses this section to decide if you have the stamina for an 8-hour workday. If you write “I take care of my kids all day,” the examiner may infer you can do light work, even if you meant your spouse really runs the household. The consequence is a higher RFC and a likely denial.

A real example: Linda Park, a fibromyalgia claimant, wrote “6:30 a.m. – wake up stiff, take 30 minutes to get out of bed; 7:00 a.m. – husband makes breakfast because I cannot stand at the stove; 9:00 a.m. – rest on couch with heating pad…” Her detailed timeline lined up with her rheumatology notes and helped her win at the reconsideration level.

Section C: Personal Care

Section C asks if your conditions affect dressing, bathing, hair care, shaving, feeding yourself, using the toilet, and other personal tasks. Each “Yes” needs a specific reason. “I cannot reach my feet to put on socks because of my back” is far stronger than “hard to dress.”

POMS DI 22510.005 directs examiners to compare these answers with treating-source notes. If your physical therapist wrote that you struggle with lower-body dressing, your form should say so in the same words. The consequence of mismatch is lost credibility.

A common misconception is that mental health claimants should leave Section C blank because their problems are not physical. Depression, PTSD, and severe anxiety often cause hygiene issues, like skipping showers for days. State that openly; courts consider it under the “B criteria” of the mental disorder Listings.

Section D: Meals, House, and Yard Work

This section asks how often you cook, what you cook, how long it takes, and whether your habits changed since your conditions began. It also asks about chores, yard work, and why you cannot do certain tasks. Be exact about frequency, like “once a week, sandwiches only, 10 minutes.”

The agency uses cooking and chores as proxies for sustained concentration, standing, and lifting. Saying you cook “full meals daily” suggests you can stand for an hour, which the examiner will turn into an RFC for light work. The consequence is denial under Step 5 of the sequential evaluation.

A real example: Robert Singh, a cardiac claimant, wrote “I microwave frozen meals 3 times a week; my daughter does laundry because I get short of breath carrying the basket up stairs.” That answer matched his cardiology notes about NYHA Class III symptoms and supported a “sedentary” RFC.

Section E: Getting Around

Section E asks how often you go outside, how you travel, whether you can go alone, and whether you drive. Many claimants answer “yes, I drive” without explaining limits, which can be fatal to the claim.

If you only drive 5 miles to medical appointments, write that. If pain medication makes you avoid the highway, write that. The consequence of an unqualified “yes” is the examiner concluding you can commute to a job.

A common misconception is that admitting you drive at all hurts your case. It does not, as long as you explain the limits. The Eighth Circuit in Reed v. Barnhart made clear that limited driving does not equal the ability to work full-time.

Section F: Hobbies and Social Activities

This section asks what you do for fun, how often, and how your conditions changed your hobbies. The agency reads this for two reasons: to test concentration and to test social functioning, both of which matter for mental Listings 12.04, 12.06, and 12.15.

If you used to play softball but now only watch TV “for 15 minutes before I lose focus,” say so. If you stopped going to church because crowds trigger panic attacks, say so. The consequence of “I still hang out with friends” without context is a finding of mild social limits, which usually defeats a mental claim.

A real example: Aisha Brown, a PTSD claimant, wrote “I used to bowl in a league; now I avoid the bowling alley because the noise causes flashbacks. I see my sister once a month for 30 minutes.” Her ALJ cited that exact passage when finding her “markedly limited” in social interaction.

Section G: Abilities

Section G is a checklist of physical and mental functions: lifting, squatting, bending, standing, reaching, walking, sitting, kneeling, talking, hearing, stair-climbing, seeing, memory, completing tasks, concentration, understanding, following instructions, using hands, and getting along with others. Each box you check needs a why in the lines below.

Writing “I can walk 5 minutes before I need to rest 20 minutes” gives the examiner a measurable limit. Writing “walking is hard” is useless. The consequence of vague answers is an RFC for “medium” work, which knocks out most claimants over 50 under the Medical-Vocational Guidelines.

A common misconception is that you must check every box to win. Honesty matters more than volume; checking boxes you do not have problems with can destroy your credibility on the boxes you do.

Section H: Medications and Treatments

Section H asks for a list of medicines, who prescribes them, what they treat, and side effects. Side effects are often left blank, which is a costly mistake. Drowsiness, nausea, dizziness, and brain fog all reduce your RFC under SSR 96-8p.

If your gabapentin causes drowsiness for 3 hours after each dose, write that. The consequence of leaving side effects blank is an RFC that ignores them entirely, even though they may be the strongest reason you cannot work.

Section I: Remarks

The Remarks page is your closing argument. Use it to add anything that did not fit, like bad-day vs. good-day patterns, flares, hospital visits, or a one-paragraph summary of the worst parts of your conditions. Reference your treating doctors by name to show the examiner where to verify your claims.

Three Common Scenarios on Form SSA-3380-BK

Claimant Action	DDS Outcome
Writes “I cook simple meals” without time limits	Examiner assumes 30+ minutes standing; light RFC issued
Lists only one condition in Section A	Combined-effects analysis weakened; denial likely
Leaves medication side effects blank	RFC ignores fatigue and drowsiness; denial at Step 5

Detailed Answer Style	Likely Examiner Reaction
“Walk 200 feet, rest 10 minutes, repeat”	Sedentary RFC supported
“Shower twice a week because of fatigue”	Mental and physical limits both credited
“Drive only to doctor, 3 miles, with breaks”	Commuting ability questioned

Mistake on the Form	Long-Term Consequence
Inconsistent dates with medical records	ALJ cites contradiction at hearing
Hand-written answers in pencil	Form may be returned; deadline missed
Skipping Remarks page	Lost chance to frame the case

Three Named Examples in Action

Example 1: David Nguyen, age 54, with degenerative disc disease. David writes that he can lift “a gallon of milk, but only with both hands and not above shoulder level.” That single sentence aligns with his orthopedic surgeon’s 10-pound restriction and supports a sedentary RFC, which under Grid Rule 201.14 directs a finding of disabled.

Example 2: Sarah Mitchell, age 38, with major depressive disorder and generalized anxiety. Sarah writes that she “cannot finish a 30-minute TV show without losing track of the plot” and “skips showers 4 days a week.” Her psychiatrist’s notes confirm the same patterns, and the examiner finds her markedly limited in concentration under Listing 12.04.

Example 3: Marcus Reed, age 47, with congestive heart failure. Marcus writes that he “becomes short of breath after walking 50 feet on level ground” and lists furosemide with the side effect of frequent bathroom trips every 90 minutes. His cardiologist’s notes support NYHA Class III, and his RFC is reduced to less than sedentary, which wins at Step 5.

Mistakes to Avoid on Form SSA-3380-BK

Many claimants lose at the initial level for the same handful of preventable errors. Knowing these mistakes can save you months of appeals.

• Vague answers like “hard to walk” — the examiner cannot measure them, so the RFC defaults higher.
• Overstating abilities out of pride — saying you “still take care of yourself fine” can defeat a claim built on disability.
• Understating abilities — claiming zero function when records show otherwise destroys credibility under SSR 16-3p.
• Leaving sections blank — blanks are read as “no limits” by examiners trained under POMS DI 22510.
• Skipping side effects — drowsiness and nausea drive RFC reductions, and missing them costs cases.
• Contradicting medical records — the examiner cross-checks every answer, and conflicts trigger denials.
• Failing to mention bad days — flares and episodes are core to fibromyalgia, lupus, and mental health claims.
• Missing the deadline — late forms can lead to technical denial and a forced restart.
• Using only checkboxes in Section G without explanations — the agency wants the why, not just the what.
• Forgetting to sign and date — an unsigned form is invalid and is returned.

Dos and Don’ts

The right habits keep your form aligned with your records and the law.

• Do answer every line, even if the answer is “no change.”
• Do measure your limits in minutes, feet, pounds, and frequency.
• Do match your wording to your treating doctors’ notes.
• Do describe a typical bad day as well as a typical day.
• Do sign, date, and keep a copy before mailing.
• Don’t exaggerate or minimize your symptoms.
• Don’t use medical jargon without a plain-English follow-up.
• Don’t rely on memory; check your medication list and journal.
• Don’t leave the Remarks page empty.
• Don’t mail the form without proof of delivery.

Pros and Cons of Filling Out the Form Yourself

Some claimants do well on their own, while others benefit from help. Weigh the trade-offs before you start.

• Pro: You know your day-to-day life better than anyone.
• Pro: Free to complete, no representative fee.
• Pro: Fast turnaround if you start early.
• Pro: Builds your familiarity with the case file.
• Pro: No middleman to misquote you.
• Con: Easy to overstate or understate without legal training.
• Con: No one to flag inconsistencies with medical records.
• Con: Hard to know which details matter most under the Listings.
• Con: Risk of missing the 10-day deadline.
• Con: No one to help you draft the Remarks section strategically.

Federal vs. State Nuances

SSA disability rules are federal, but the state DDS offices apply them, and small differences exist. California DDS, for example, often requests a third-party Function Report (Form SSA-3380-BK companion SSA-3380) more aggressively than Texas DDS. Knowing your state’s habits helps you prepare.

Some states, like New York and Florida, are part of SSA’s Compassionate Allowance pilot regions, which can speed processing for serious conditions. Other states have heavier backlogs, with average wait times exceeding 9 months. The consequence is that your Function Report may sit unread for months, so accuracy at the time of mailing is critical.

A real example: Karen Wilson in Florida sent her form by certified mail, kept the receipt, and called DDS weekly. Her examiner had her file ready within 60 days, and her claim was approved. The consequence of not tracking the form is examiners closing files for “non-cooperation” under POMS DI 23007.010.

Key Court Rulings Shaping Function Reports

Federal courts have spoken many times on how SSA must read the Function Report. In Bjornson v. Astrue, the Seventh Circuit warned ALJs against using boilerplate to dismiss credible symptom statements. The consequence is that examiners must explain why they discount your answers.

In Garrison v. Colvin, the Ninth Circuit held that ALJs cannot equate basic ADLs with the ability to work full-time. That is why your wording matters: “I make a sandwich” is not the same as “I can stand at a deli counter for 8 hours.”

In Biestek v. Berryhill, the U.S. Supreme Court emphasized the “substantial evidence” standard, meaning your Function Report can be the deciding piece if it is detailed and consistent. A common misconception is that medical records alone win the case; in reality, your words on the form often tip the balance.

Strategic Tips for Stronger Answers

Use measurable units in every answer, like “10 minutes,” “5 pounds,” or “twice a week.” Examiners are trained to translate measurable limits into RFC findings under SSR 96-8p. The consequence of measurable language is a defensible RFC; the consequence of vague language is a default to higher work levels.

Describe bad days as well as typical days, because SSR 12-2p for fibromyalgia and the mental Listings both require analysis of waxing and waning symptoms. If your good days come once a month, say so. The consequence of describing only average days is an RFC that ignores the worst of your condition.

Reference your treating doctors by name in the Remarks section, and quote a phrase or two from their notes if you can. The consequence is faster verification by the examiner. A common misconception is that you cannot quote your doctor; you can, as long as the words are accurate.

Frequently Asked Questions

Do I have to fill out Form SSA-3380-BK?

Yes. Refusing to complete the form can lead to a denial for failure to cooperate under 20 C.F.R. § 404.1516, which closes your case without a medical decision.

Can I get help filling out the form?

Yes. A friend, family member, attorney, or representative can help you write, but you must sign it yourself, and the form should note who assisted you in the Remarks page.

Can I type my answers instead of writing by hand?

Yes. SSA accepts typed answers, and the fillable PDF on ssa.gov is designed for that purpose, which also makes the form easier for examiners to read.

Will SSA send a similar form to my friends or family?

Yes. SSA often mails a Function Report – Third Party (SSA-3380) to a person who knows you, and conflicts between your answers and theirs can hurt credibility under SSR 16-3p.

Can my doctor fill out the form for me?

No. The form is your statement, not a medical opinion, and doctors instead complete Form HA-1151 or Medical Source Statements to support your case.

Do I have to list every medication?

Yes. Section H requires every prescription, and missing one can suggest your treatment is lighter than it really is, which lowers your RFC restrictions.

What if I miss the deadline?

No, missing it is not always fatal, but you must call DDS right away to ask for an extension under POMS DI 23007.005, or the agency may deny for non-cooperation.

Should I describe a good day or a bad day?

Yes, describe both, because SSR 16-3p and SSR 12-2p require the agency to weigh symptom variability across time, not just an average day.

Can my answers be used against me at a hearing?

Yes. ALJs frequently quote Function Report answers at hearings, so consistency between your form, your testimony, and your medical records is essential.

Do I need to send proof with the form?

No, extra evidence is not required, but attaching a current medication list or pain diary is allowed and often strengthens credibility under 20 C.F.R. § 404.1512.

Will filling out the form trigger a consultative exam?

Yes, sometimes; if your answers conflict with the medical record or records are sparse, DDS may schedule a consultative examination to gather more proof.

Can I submit a new Function Report on appeal?

Yes. At reconsideration and hearing, you can file an updated SSA-3380-BK, and many representatives recommend doing so to capture worsening conditions and new treatment.