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Filing the Adult Disability Report (SSA Form 3368)

Frank J. Dito, Jr.
Car accident, personal injury and workers’ compensation attorney serving Staten Island and Brooklyn New York.

When seeking to file for Social Security disability benefits you will need to submit 3 main forms: the Disability Benefit Application, Authorization to Disclose Information to the SSA, and the Adult Disability Report. The Adult Disability Report is a 14-page, 11-section document that collects information on your medical history, education and work.

Information Requested on the Adult Disability Report

When filing a Social Security disability benefits claim you need to provide evidence of your disability, work history, and education. These topics, as well as general information and additional remarks, are all required on the Adult Disability Report.

The 11 sections of the Adult Disability Report are: 

  • Information about the disabled person;
  • Contacts;
  • Medical Conditions;
  • Work Activity;
  • Education and Training;
  • Job History;
  • Medicines;
  • Medical Treatment;
  • Other Medical Information; and
  • Vocational Rehabilitation, Employment or Other Support Services; and
  • Remarks. 

The 10th section, Vocational Rehabilitation, Employment or Other Support Services, is required only if you are already receiving Supplemental Security Income (SSI) benefits.

Necessary Information for Filing the Adult Disability Report

You will need to provide many personal details about your medical and work history to complete the Adult Disability Report as part of your application for Social Security disability benefits. It's best to consult the SSA's checklist for applying for Social Security disability benefits before filling out the Adult Disability Report as it will help you gather the necessary documentation to refer to for the information requested.

The medical information you will need to have to complete the Adult Disability Report are the medical records for all treatment related to your disability, contact information for the treating medical professionals, names of medications you are taking and their prescribing physician, records of medical tests and who requested them.

Work related information includes the names and contact information of your last 5 jobs, as well as the dates you worked there. Information on insurance or Workers' Compensation claims you filed are also required as part of your work history for the Adult Disability Report.

How to File the Adult Disability Report 

The Adult Disability Report may be completed and filed online or on paper and mailed or brought to an SSA office for submission. You are allowed to ask another person to help you fill out the form if you are unable to complete it yourself.

Appropriate persons to help you file the Adult Disability Report for a Social Security disability benefits claim are: 

You should not have a health care provider assist you in completing this report.

Contacting a New York Social Security Disability Lawyer 

Before you file your Social Security disability claim, be sure to take advantage of this free consumer's guide: 5 Mistakes to Avoid When Filing a Social Security Disability Claim. Contact a New York Social Security disability lawyer at The Law Offices of Frank J. Dito, Jr. for help in building your disability claim at 800-310-5520.