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This directory is under active review and may be incomplete. Confirm urgent details directly; No One Left Outside does not guarantee eligibility, availability, funding, acceptance, or placement.

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Disability and agingSupporting documentconditional

Social Security Function Report — Adult

Official owner Social Security Administration

Claimant account of daily activities and abilities requested for disability review.

What problem this helps solve

Claimant account of daily activities and abilities requested for disability review.

Who completes it: Claimant or helper reporting claimant's activities; form says not doctor/hospital.

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 checked

Ten-page 08-2026UF form read; discontinues prior editions. Completion/help instructions and end-page completer fields checked.

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

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Direct document

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

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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
Requested claimant functional evidence
Who completes it
Claimant or helper reporting claimant's activities; form says not doctor/hospital.
Jurisdiction
United States
Application mode
Paper report; Requesting-office assistance

2. Prepare before starting

  • Read requesting letter and provide specific activity/ability information.

Documents named by the source

  • Activity/ability information and help received; exact additional evidence depends on request.
Fees and fee waivers
UNKNOWN — no filing fee stated in checked form.
Account
No account stated for paper; electronic route UNKNOWN.
Appointment
UNKNOWN — call requesting office for help.
Signature
Completer name/address/date fields on last page; no separate signature located. Follow request letter.
Third-party certification or assessment
Unknown — confirm any certification, referral, or assessment with the official owner.

3. Follow official submission instructions

Read official instructions
  • Return to office that requested it using supplied letter instructions

4. Get help or an accommodation

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

  • Keep copy and return to requesting office by notice instructions.

Restrictions and unresolved details

  • Report is not a medical provider form.
  • Distinguish this self-report from third-partySSA-3380.
  • Do not leave unknown/not-applicable responses blank contrary to form instructions.

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.

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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 Function Report — Adult
Form number
SSA-3373-BK
Program
SSI and SSDI disability evidence
Jurisdiction
United States
Revision / edition
Aug 2026
Who completes it
Claimant or helper reporting claimant's activities; form says not doctor/hospital.
Signature
Completer name/address/date fields on last page; no separate signature located. Follow request letter.
Submission methods
Return to office that requested it using supplied letter instructions
Supporting documents
  • • Activity/ability information and help received; exact additional evidence depends on request.
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.

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  • • 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.

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