SAMHSA SOAR

About the Function Report: SSA-3373

The Function Report (SSA-3373) helps DDS to obtain information about how an applicant’s illness(es) and condition(s) affect their ability to function and perform everyday tasks.

The SSA has an optional form called the Function Report that DDS uses when they are in need of additional information about how an applicant is able to function in everyday life.  They will often refer to the form as “The ADLs” or the “ADL questionnaire.”   They are referring to activities of daily living, which are things that we do on a daily basis like cooking, cleaning, bathing, etc.  The form also asks questions about the applicant’s ability to function in social settings and what physical limitations they might be experiencing. 

When is it Required?

DDS requires the completion of the SSA-3373 when they do not have enough information in the medical records to determine whether the person’s impairments are keeping them from being able to function in a work environment. 
  • Some state DDS offices will require an SSA-3373 with every application
  • Many states will accept the SOAR Medical Summary Report (MSR) with a comprehensive description of functioning in place of the official form
  • Check with your State Team Lead for the SOAR process in your state

Completing the SSA-3373

It is important to complete the SSA-3373 in the applicant’s own words. 
  • Describe their struggles on their worst days
  • Help the applicant to describe specific scenarios using open-ended questions
  • Always expand on the Yes/No answers with more detailed explanations
  • You may be able to use information gathered from the MSR worksheet to help complete the questions on the SSA-3373
  • When answering the questions re medications, include prescription and non-prescription medications and focus on the side effects experienced
  • Utilize the Remarks section and additional pages to provide additional description and examples
  • Be sure to indicate that you helped complete the form on the last page and add “SOAR” in the Remarks section

Submitting the SSA-3373

  • Fax the form back to the DDS examiner using the provided barcoded cover sheet
  • In some states the SSA-3373 is required for all applications; in these instances complete the report and submit with your complete SOAR application packet
You can access a copy of the SSA-3373 here: http://www.socialsecurity.gov/forms/ssa-3373-bk.pdf

Details

Type:
SSA Forms
Date:
October, 2013

Other Details