Form SSA-3368-BK Disability Report - Adult

Form SSA-3368-BK Instructions

The instructions for filling out the SSA Disability Report can be found on the first two pages of the form. Read them attentively, detach them, and keep them for your reference. Although the form is very lengthy, do not leave any box unfilled, unless indicated otherwise. If you do not know the answer or the suggested answer does not apply, write, "don't know," or "does not apply." In case you feel any difficulties with the form, fill in as much as you can. You can ask a Social Security representative to help you with the rest.

Do not ask your doctor or medical facility to complete this disability report. If you have your medical reports, submit them with the completed form. If your medical records are kept by your healthcare provider, the SSA will request them on your behalf with your permission. The information this form contains will tell the agency where to request your records.

How to Fill Out SSA-3368-BK and Receive Disability Approval?

SSA Form 3368-BK consists of 14 pages, 12 of which are the form you need to fill out. Any mistake on the form may lead to delay or denial of your benefits.

1. Section 1 ("Information about the Disabled Person") is self-explanatory and requires your personal information. If you cannot speak and understand English, indicate it in this section and specify the language you prefer. The SSA will provide you with a translator or interpreter at no cost to you.
2. Provide information about a person who knows about your medical condition and can help you with your application in Section 2 ("Contacts"). It can be anyone except for doctors that treat or have treated you.
3. Make sure you list every disability, illness, or other medical condition you have in Section 3 ("Medical Conditions"). A person with several medical conditions gets approval more often even if none of these conditions qualifies if taken separately.
4. Describe how your medical condition affects your ability to work and the restrictions it places on you in Section 4 ("Work Activity"). Do not exaggerate your condition, but do not downplay it either.
5. Section 5 ("Education and Training") is self-explanatory.
6. Make sure you list all the jobs you have had over the last 15 years in Section 6 ("Job History"). Provide all the required details. If you conceal any part of the information required for this section, it may result in denial of your claim.
7. List all the medications you take (including pain relievers) in Section 7 ("Medicines").
8. List all health care professionals you have visited, are visiting, or are going to visit in Section 8 ("Medical Treatment"). Provide all the requested information as accurately as possible.
9. If anyone else has information about your physical and mental condition, indicate their contact information in Section 9 ("Other Medical Information").
10. Fill out Section 10 ("Vocational Rehabilitation, Employment, or Other Support Services") only if you receive Social Security Income.
11. Provide any sufficient additional information or explanations in Section 11 ("Remarks").

Where Should I Mail Completed SSA-3368-BK?

Mail the completed SSA Disability Report to the specific office that requested it. Find the address of all the SSA offices on their official website. The full list of offices is also provided in your phone directory under U.S. Government Agencies. One more way to specify the address you need is to call the SSA at the phone number provided on the second page of the form.

Not what you were looking for? Check out these related forms:

• Form SSA-3820-BK, Disability Report - Child, is a form you need to complete when you request Social Security benefits on the behalf of a disabled child;
• Form SSA-16, Application for Disability Insurance Benefits, informs the recipient of the SSA disability benefits about the necessity to report specific changes;
• Form SSA-3441-BK, Disability Report - Appeal, is a form you need to fill out if your Social Security disability claim was denied. The document is used to update the information you have provided.