Social Security Function Report — Adult, Third Party
Official owner Social Security Administration
A third party describes their own knowledge of the claimant's daily activities and abilities.
What problem this helps solve
A third party describes their own knowledge of the claimant's daily activities and abilities.
Who completes it: Third party with direct knowledge. Form expressly says not to ask the claimant to provide the answers or ask doctor/hospital 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
Ten-pagePDF cover says 08-2026; internal footers say 07-2026. Cover explicitly allows 12-2023until stock exhausted. Cover month normalized 2026-08-01; internal discrepancy preserved.
Last checked Sep 30, 2026. A working link does not establish the current edition, suitability, agency acceptance, or service availability.
Direct document
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Open official documentUse 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 third-party functional evidence
- Who completes it
- Third party with direct knowledge. Form expressly says not to ask the claimant to provide the answers or ask doctor/hospital to complete it.
- Jurisdiction
- United States
- Application mode
- Third-party paper report; Requesting-office help
2. Prepare before starting
- Third party should report what they know independently.
Documents named by the source
- Third party's own observed activity/ability information and relationship details.
- Fees and fee waivers
- UNKNOWN — no filing fee stated in checked form.
- Account
- No account stated for paper; electronic route UNKNOWN.
- Appointment
- UNKNOWN — contact requesting office if help needed.
- Signature
- Completer name/address/date fields; no separate signature located. Follow agency request.
- 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
- 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
- Keep copy and return by supplied instructions.
Restrictions and unresolved details
- Do not fill claimant's self-report in place of independent observations.
- Mixed 07/08-2026dates and permitted12-2023stock are edition cautions, not automatic invalidity.
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
Requested third-party functional evidence
Return to step: Gather health and work history
Form record
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- Official title
- Social Security Function Report — Adult, Third Party
- Form number
- SSA-3380-BK
- Program
- SSI and SSDI disability evidence
- Jurisdiction
- United States
- Revision / edition
- Aug 2026
- Who completes it
- Third party with direct knowledge. Form expressly says not to ask the claimant to provide the answers or ask doctor/hospital to complete it.
- Signature
- Completer name/address/date fields; no separate signature located. Follow agency request.
- Submission methods
- Return to office that requested it using supplied letter instructions
- Supporting documents
- • Third party's own observed activity/ability information and relationship details.
- 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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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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