When you apply for Social Security Disability you are asked to fill out a Function Report. You can find a copy here (SSA-3373)
Social Security attorneys and medical professions refer to this as an ADL questionnaire (Activities of Daily Living). This is one of the most important parts of your application, and sadly many people do not spend the time to fill it out properly. Here are some tips to assist you in filling out your SSA-3373 form well.
1.Be honest! I can not stress this enough, your activities of daily living are going to be compared with your medical records, the people evaluating your
disability claim see thousands of these forms, and they review even more medical records. If you exaggerate the things you can not do or the symptoms that
you experience it will show and you will damage your claims credibility. This will negatively affect your claim in the future even if it goes to a hearing before
an Administrative Law Judge. The Function Report is one of the first things an Administrative Law Judge (ALJ) will look at when reviewing your claim. If
the ALJ does not think your claim is credible it will be almost impossible to get a favorable decision.
- Be thorough, and don’t procrastinate. Keep track of the deadlines Social Security gives you to submit your report, you want to send it back on time and it could take several hours to complete it well.
- Pay special attention to question 5. Do not just list symptoms of your conditions here. Question 5 should specifically describe what tasks you could not do at your former jobs that caused you to stop working or be terminated. Also remember Social Security will evaluate the work you have done for the Past 15 years, if you left one job due to a disability and tried another job but still could not do that job, make sure you include the issues you had at BOTH jobs.
I could no longer type on a keyboard or write memos.
I could not lift and carry (my tools or supplies).
I could no longer climb a ladder to (work on rooftops).
I could no longer climb stairs to do my (work).
I could no longer bend over to (pick up things) on the job.
I got dizzy from my medication and could no longer operate a (machine at work).
I could no longer be around my co-workers or work with the public due to (depression, anger, hallucinations, anxiety).
I could not complete (tasks) on time because I could not stay focused.
I was no longer able to understand instructions or follow orders from supervisors to complete (work assignments) on time.
I became tired and had to take more breaks than were allowed.
I was missing too many days at work due to my condition and doctor visits.
My job required a lot of walking which I can no longer due.
I could not stand on my feet long enough to complete (work tasks).
I could no longer reach, grab, or handle (things) at work, I often dropped (things).
Side effects of my medications prevent me from (completing work tasks).
My vision even with glasses was too poor to see well enough to (complete work tasks).
Never include answers such as “Bad economy” “Company down sizing” “Boss hired younger person to do my job”. Even if these things affected you, this is not the place to include this information
- Don’t limit any of your answers because the form only has a few lines. Write or type your answers on a separate piece of paper and title it “QUESTION RESPONSES” on the form write in “PLEASE SEE SEPARATE PAGE(S) FOR ANSWERES”
- Question 6 can make or break your claim, be honest but be clear and complete. Question 6 asks you to describe what you do from the time you wake up until you go back to bed at night. Most people with disabilities have “good days” and bad days”. Make sure you clearly identify and describe what you do on a good day, and on a bad day. You can give an honest estimate of how many good days you have a week. Always be very, very, very, complete. Here is an example of what a good day COMPLETE description may look like:
If I am having a good day (about 4 per week) I wake up at 7 AM and am able to get out of bed and go to the bathroom. My (wife, husband, partner, etc.) helps me take a bath or shower and get me my medication, this can take about an hour so around 8 AM I have a cup of coffee and microwave an egg and sausage muffin or put some frozen waffles in the toaster. Some mornings I just eat a bowl of cereal. I use mostly paper plates and bowls because doing dishes is hard for me. My medication affects my concentration so if I got mail from the day before I try to open it in the morning and read it before the medication side effects kick in. Sometimes I make a phone call or two if I have to make a doctors appointment or arrange for a ride. Sometimes a friend or family member has left a message and I call them back. I rarely can answer the phone before it goes to voicemail; this is ok since I don’t like to talk to people much anyway. Around 10 AM I move to the couch to lie down and I put the TV on. Usually I put on talk shows, I don’t pay too much attention to them but they make me feel like I have a friend around that I don’t have to talk to. I usually fall asleep on the couch because my medication has made me sleepy and I wake up around 1PM. If the news is on I turn it off because it bothers me, it is to depressing and makes me feel like I am missing out on what’s going on in the world around me. I then eat lunch; usually a sandwich or I may reheat leftovers in the microwave. I usually go to the bathroom after lunch and around 2:30 I will go out side to get my mail. My driveway is only about 25 yards and I feel like I have accomplished something when I get my own mail. If the weather is nice I sit on my porch lounge chair for 20 or thirty minutes and enjoy some fresh air.
A COMPLETE description of a bad day may be like this:
If I am having a bad day (about 3 per week) I am awake in bed around 4 AM because the pain has woken me up. I have a bell next to my bed so I can alert my (husband, wife, partner, etc.) to come help me. They give me my medicine and help me use the bathroom. I lie back in my bed and hope the pain gets better. I don’t even try to get out of bed and I just try to get in a comfortable position. Sometimes listening to music helps to distract me from the pain, and I can go back to sleep. Around 12:30 my (husband, wife, partner, etc.) comes home from work to check on me and they bring me something to eat. I try to eat something and then they help me use the bathroom again. If I feel a little better I will go lie on the couch and put the TV on. Usually I put on talk shows, I can’t pay too much attention to them but they make me feel like I have a friend around that I don’t have to talk to. I take more medicine and take a nap for a few hours. When my (husband, wife, partner, etc.) gets home around 5 PM they wake me up and make me dinner. Sometimes they help me shower or take a bath and then I go back on the couch for another hour or two.
You may do household chores during the day, if you do include them in your description but be very clear how you do them, for how long, if someone helps you, or if you have to take breaks or rest between activities. For example:
I can put clothes in the front loading washing machine; I use a basket that has wheels to help me. I then go lye down and rest. When it’s done washing I have a chair that I sit on in front of the washing machine and I slowly move the clothes into the front loading dryer. When my (husband, wife, partner, etc.) gets home they unload the dryer and we both do the folding. They put away the clean laundry for me.
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