Disability and agingSupporting documentconditional

Social Security Disability Report — Adult

Official owner Social Security Administration

Initial adult disability evidence report identifying condition, treatment, medicines, work/education and people who can help.

What problem this helps solve

Initial adult disability evidence report identifying condition, treatment, medicines, work/education and people who can help.

Who completes it: Claimant or knowledgeable friend/family helper. Form expressly says not to ask healthcare provider to complete it.

What this does not prove

Follow the requesting agency and notice; evidence report alone is not an application, appeal or approval.

Dated source check

Official destination opened — currentness caution

Fifteen-page 06-2024UF report read; discontinues prior editions. Printed earnings question reflects older edition; do not convert it into current eligibility guidance.

Last checked Sep 30, 2026. A working link does not establish the current edition, suitability, agency acceptance, or service availability.

Open official source page

Direct document

Before downloading, confirm the agency, form number, and revision date match the summary below.

Open official document

Use the official pathway

NOLO's preparation notes summarize the dated sources in this record. Follow the agency's official instructions and current edition when they differ.

1. Check that this route fits

Stage and purpose: Initial adult disability report
Who completes it: Claimant or knowledgeable friend/family helper. Form expressly says not to ask healthcare provider to complete it.
Jurisdiction: United States
Application mode: Paper report; Online claim when applicable; Agency-assisted completion

2. Prepare before starting

Match report to the person's initial claim and request letter.

Documents named by the source

Provider/contact, treatment, medicine, education and five-year work details.
SSA can request medical records after appropriate consent; no universal requirement to buy copies.

Fees and fee waivers: UNKNOWN — no filing fee stated in checked form.
Account: UNKNOWN for online transaction; paper report states no account requirement.
Appointment: UNKNOWN — request office help.
Signature: Section12 asks completer identity and date; no separate handwritten signature located. Accompanying claim/releases have their own requirements.
Third-party certification or assessment: Unknown — confirm any certification, referral, or assessment with the official owner.

3. Follow official submission instructions

Read official instructions

Send or bring to requesting/local SSA office; follow letter
Adult online application route may collect report information

4. Get help or an accommodation

Social Security — 800-772-1213; TTY 800-325-0778
Get help with the actual claim, report, appeal, payee or card task. Ask SSA which office provides that service and whether an appointment is needed before traveling.

Languages: English form read; request SSA language help.

Accessibility: PDF conformance not evaluated. Use requesting-office help for inaccessible forms or inability to complete them.

5. Know the supported next step

Return report to requesting office and keep a copy.
Follow additional evidence requests.

Restrictions and unresolved details

Report is distinct from the benefit application and SSA-827 consent.
Old printed dollar questions do not establish present-day eligibility.
Do not ask doctor/hospital to complete this claimant report.

Follow the requesting agency and notice; evidence report alone is not an application, appeal or approval.

Continue with your journey

Return to the connected step to decide what to do next. Opening this record does not complete that step or submit an application. If the official route is unavailable, use the assistance options above or browse help in the journey.

Applying for SSI or SSDI
- Initial adult disability report
  Return to step: Gather health and work history
Browse help for Applying for SSI or SSDI

Back to all forms and portals

Form record

Adds to a private plan in this browser tab. Nothing is sent to the provider, and nothing is applied for.

Official title: Social Security Disability Report — Adult
Form number: SSA-3368-BK
Program: SSI and SSDI disability evidence
Jurisdiction: United States
Revision / edition: Jun 2024
Who completes it: Claimant or knowledgeable friend/family helper. Form expressly says not to ask healthcare provider to complete it.
Signature: Section12 asks completer identity and date; no separate handwritten signature located. Accompanying claim/releases have their own requirements.
Submission methods: Send or bring to requesting/local SSA office; follow letter, Adult online application route may collect report information
Supporting documents: • Provider/contact, treatment, medicine, education and five-year work details.
• SSA can request medical records after appropriate consent; no universal requirement to buy copies.
Languages: English form read; request SSA language help.
Accessibility: PDF conformance not evaluated. Use requesting-office help for inaccessible forms or inability to complete them.

Related NOLO journeys

Use a journey to prepare for documents, blockers, and backup routes around this destination.

Applying for SSI or SSDI

Before sharing information

• Check that the address begins with https:// and matches the agency above.
• Read the agency’s privacy and consent language before entering personal information.
• Save a confirmation or reference number if one is provided.
• If a page asks for payment unexpectedly, stop and confirm the fee with the agency.

Source note: Follow the requesting agency and notice; evidence report alone is not an application, appeal or approval.

NOLO does not process this form, receive your answers, decide eligibility, or represent the agency. A destination check does not confirm current funding, acceptance, or an outcome.

Report a broken or changed source