Form SSA-3368: Filling Out the Adult Disability Report

Form SSA-3368-BK, known as the Adult Disability Report, is the central document Social Security uses to collect your medical history, treatment sources, medications, and work background. To complete it successfully, you must list every physical and mental condition that limits your ability to work and provide complete contact details for all healthcare providers who have examined or treated you. Taking time to provide thorough, accurate responses prevents unnecessary developmental delays as your claim moves into medical evaluation.

The Role of Form SSA-3368 in the SSDI Process

Form SSA-3368-BK is not your legal application for benefits, which is Form SSA-16-BK, but it is the evidentiary engine of your Social Security Disability Insurance (SSDI) claim. Once your local field office confirms your work credits and technical eligibility, it forwards your claim to Disability Determination Services (DDS). DDS is the state-level agency responsible for gathering medical records and making disability determinations under 20 CFR 404.1503.

Under 20 CFR 404.1512, you are responsible for providing medical evidence showing the existence and severity of your impairments. Form SSA-3368-BK tells the state examiner who has treated you, where your records are stored, and what medical testing you have undergone. Without this roadmap, the DDS examiner cannot request your medical records, and your claim will sit idle at the field office.

You can complete Form SSA-3368-BK online at ssa.gov as part of your electronic application, or complete a physical paper document. The electronic version allows you to save your progress using a re-entry number. Because the form requires extensive factual information, reviewing each section before you sit down to fill it out saves hours of searching for old paperwork.

Section 1 and Section 2: Personal Information and Contacts

The opening sections collect your standard biographical details, including your full legal name, Social Security number, address, telephone number, and primary language. Accuracy here ensures you receive time-sensitive letters and questionnaires from DDS examiners during the evaluation process.

These sections also request an alternate contact person who knows about your medical conditions and can reach you if your contact information changes. Choosing a dependable friend, relative, or neighbor is vital. Under SSA operational guidelines in POMS DI 11005.020, if an examiner cannot reach you by telephone or mail, they attempt to contact your designated third party. If SSA cannot locate you, the agency can deny your claim for failure to cooperate under 20 CFR 404.1518.

Section 3: Medical Conditions

Section 3 asks you to list all physical and mental impairments that limit your ability to work. When answering this question, list every condition diagnosed by a healthcare provider, not just the primary ailment that forced you to leave your job.

Claimants frequently make the mistake of listing only a single physical injury, omitting secondary conditions such as depression, anxiety, chronic pain, or diabetes. Under 20 CFR 404.1523, SSA is legally required to consider the combined effect of all your physical and mental impairments, even if no single condition is severe enough on its own to meet the disability threshold. Documenting every diagnosed condition ensures that examiners look at your entire health profile rather than an isolated symptom.

Section 4 and Section 5: Work Activity and Education

These sections capture your work history timeline and your educational background. You must provide the date your medical conditions first began affecting your ability to work, and the specific date you stopped working altogether or reduced your hours.

In Social Security practice, the date your health forced you to stop working is known as your alleged onset date (AOD). This date must align with your actual earnings records and payroll documentation. If you claim an onset date while your earnings records show you were working above substantial gainful activity levels, SSA field office staff will require clarification before processing can proceed.

Section 5 asks about your highest grade completed, vocational training programs, and language literacy. DDS examiners use your educational background at Step 5 of the sequential evaluation process under 20 CFR 404.1564 to determine whether your skills transfer to other occupations in the national economy.

Section 6 and Section 7: Medical Providers and Hospital Visits

The medical provider sections form the most critical part of Form SSA-3368-BK. In these sections, you must provide exhaustive details for every doctor, specialist, hospital, clinic, therapist, and emergency room that has evaluated or treated you.

For every healthcare provider, you should include:

• The exact name of the doctor, practice group, or medical facility
• Complete street address, including suite numbers, city, state, and ZIP code
• Direct telephone and fax numbers for the medical records department
• Patient identification or account numbers, if shown on your billing statements
• The approximate dates of your first visit, your most recent visit, and any future scheduled appointments
• The specific reasons for your visits and the types of treatments or therapies provided

Under POMS DI 22505.001, DDS examiners mail formal record requests to the facilities you list. Incomplete facility names or missing ZIP codes cause records requests to bounce, stalling your case for weeks. If you do not recall the exact day of a medical appointment, provide the month and year rather than leaving the field blank.

Section 8 and Section 9: Medications and Medical Tests

Section 8 requests a full inventory of all prescription and over-the-counter medications you take. You must list the medication name, the dosage, the frequency, the prescribing physician, and the health condition it treats.

Most importantly, document any adverse side effects caused by your medications. Under 20 CFR 404.1529, SSA evaluates the type, dosage, effectiveness, and side effects of any medication when determining your symptom severity. If a muscle relaxant causes severe drowsiness, or a blood pressure medication causes chronic dizziness that prevents you from standing safely, describing these effects gives examiners crucial insight into your daily limitations.

Section 9 covers diagnostic medical tests, such as X-rays, MRIs, CT scans, blood work, cardiac stress tests, and psychiatric evaluations. List the facility where each test took place and the approximate date it occurred. This information allows DDS examiners to request specific imaging records and objective clinical findings that substantiate your medical diagnosis under 20 CFR 404.1513.

Section 10 and Section 11: Work History and Remarks

Section 10 asks for basic details about the positions you held before stopping work. While SSA may send a separate, detailed Work History Report (Form SSA-3369-BK) later in the process, providing accurate job titles and typical work duties here establishes your vocational baseline. In 2026, Social Security regulations evaluate past relevant work over the 5-year period preceding your onset date under 20 CFR 404.1565.

Section 11 provides an open remarks space. Use this area to explain practical realities that do not fit neatly into standard form boxes. If you experienced a gap in medical treatment because you lost health insurance, state that plainly. Under Social Security Ruling 16-3p, SSA must consider your explanations for why you did not seek medical treatment before drawing negative conclusions about your condition.

Answering Consistently to Avoid Development Delays

DDS examiners scrutinize your completed Form SSA-3368-BK alongside your medical records and future questionnaires. Inconsistencies between your statements and your clinical charts often prompt examiners to question your reported functional limitations.

Common errors that trigger delays include:

• Leaving clinic addresses or telephone numbers blank, forcing examiners to conduct manual searches
• Omitting mental health treatment sources because of personal embarrassment or stigma
• Providing inconsistent dates for when your work stopped compared to tax filings
• Describing your job duties in vague terms instead of detailing real physical exertion
• Forgetting to submit a signed medical release, Form SSA-827, along with the report

Take time to review your answers against your personal calendar, prescription bottles, and medical bills before hitting submit. A well-documented, accurate Adult Disability Report provides DDS examiners with the evidence they need to evaluate your claim promptly.

Frequently Asked Questions

Can I update Form SSA-3368 after submitting it online? You cannot edit the electronic report after submission, but you can report new doctors, medications, or tests directly to your local field office or state DDS examiner.

What if I do not remember the exact date of every doctor visit? SSA accepts approximate dates for treatment visits, so provide the month and year if you cannot recall the exact calendar day.

Why does Form SSA-3368 ask about my medications and side effects? DDS examiners evaluate medication side effects under 20 CFR 404.1529 to determine whether symptoms like fatigue, dizziness, or nausea impair your capacity to work.

This article is general information about SSA filing procedures, not legal advice. Program rules, forms, and processing details change over time, and every situation is different. Consult a qualified representative or contact SSA directly for guidance on your specific claim.