This version of the form is not currently in use and is provided for reference only. Download this version of
Form SSA-3368-BK
for the current year.
Form SSA-3368-BK, Disability Report - Adult , is a form used to provide information when you claim Social Security disability benefits for adults. The report was issued by the U.S. Social Security Administration (SSA) with the latest version released on October 1, 2015 . An SSA-3368-BK fillable form is available for digital filing and download below.
Alternate Names:
Form SSA-3368-BK is considered one of the main documents you need to submit when applying for disability benefits. It is very extensive and requires a lot of information about yourself, your disabilities, education, job history, medicines you take, and the treatment you receive. The SSA understands the word "disability" as the inability to work. The SSA will consider you a disabled person if you are unable to do any job you are fit for and if your condition will last or has lasted longer than a year.
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.
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.
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: