Disability Report - Adult

Form SSA-3368, the Adult Disability Report, is the core medical questionnaire filed with every adult disability application. It asks you to list all physical and mental conditions that limit your ability to work, every doctor, hospital, and clinic that has treated you with dates and contact information, your medications and their side effects, and the medical tests you have had. It also collects a summary of your education, job history over the past 15 years, and when your conditions began affecting your work. The state Disability Determination Services uses this report as its roadmap for ordering records, so a provider or condition you leave out may simply never be considered in the decision.

Complete the SSA-3368 online through the disability application at ssa.gov, or on paper if you prefer, at the same time you file your SSDI or SSI application. Be exhaustive rather than modest: list every diagnosed condition, including mental health conditions, and every treatment source with accurate addresses, phone numbers, and approximate dates of service, since examiners request records based exactly on what you provide. Describe how your conditions limit work activities in plain, specific language, and include medication side effects such as drowsiness or nausea. Gather a written list of providers and prescriptions before you start so nothing is forgotten. If your treatment continues after filing, report new providers to DDS promptly. Keep a copy, because later forms and hearing testimony should stay consistent with it.