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Social Security Disability: Third Party Request & Function Report

Updated on May 13, 2013

Third Party Request – “Function Report – Adult – Third Party”

This report will be sent to the person you listed as your third party. It is a private document that goes directly to them. They are required to send it directly back to the Social Security Administration (SSA). You are not involved and do not see this document. You can request a copy of the report from who you put down as your third party, but they are not required to give it to you. For your records, you may want it though. You may want to keep track of all documents sent to the SSA and when they were sent. This may help you keep a timeline of approximately when the determination department will be making your decision.

Section A asks for General Information

This section asks for the third party's personal information, how close he or she is to you, and questions about your living arrangements. For all questions, they will need to answer truthfully and not exaggerate to make you look more disabled than you are.

Section B asks for Information about Disability

This section asks your third party about anything that has changed in your life since you have become disabled. This section wants to know what you do in your spare time and if you care for anyone else or vice versa. It asks about pets or animals. It also asks about your sleeping issues.


8. Personal Care (Explain how the disability affects your ability to):

  • Dress
  • Bathe
  • Hair Care
  • Shave
  • Feed Self
  • Toilet habits

9. Do you need any special reminders to take care of personal needs and grooming? Hopefully, you picked a person who knows you well and knows of reminders, habits, hobbies, etc.

10. Do you need medical help from others? (such as reminders to take your medication)

11. Meals:

  • Do you cook? If yes, how often do you cook, and what do you cook? Does it take you a longer than normal amount of time to cook?
  • If no, explain why you cannot or do not prepare meals.

12. House and Yard Work:

  • List household chores, both indoors and outdoors, that you are able to do.
  • How much time do chores take, and how often do you do each of these things?
  • Do you need help or encouragement to do these things? If yes, what help is needed?
  • If you don’t do house or yard work, explain why not.

13. Getting Around

  • How often do you go outside? If not much, the question asks for an explanation.
  • How do you travel when outside? They want to know your form of transportation.
  • Can you go alone?
  • Do you drive? If not, explain why not.

14. Shopping

  • How do you shop? (in stores, by phone, by mail, by computer)
  • Describe what you shop for.
  • How often do you shop and how long does it take?



15. Money

  • Are you able to pay bills, count change, handle a savings account, and/or use a checkbook? If you cannot, why is that?
  • Do you have the ability to handle money (since you were disabled)? If yes, explain.

16. Hobbies and Interests

  • Describe changes in your hobbies and interests since the disability.

17. Social Activities

  • Do you spend time with others?
  • Do you need to be reminded to go places?
  • Do you need someone to go with you?
  • Do you have trouble getting along with others?
  • Describe changes in social activities.


Section C asks for Information about Abilities

1. Are you right or left handed?

2. How far can you walk before needing to stop and rest? If this is a problem, explain.

3. How long can you pay attention? This helps them in determining mental and learning disabilities.

4. Do you finish what you start? This relates to the attention span question.

5. Do you follow written instructions?

6. Do you follow spoken instructions? There is room in these two questions to explain why you do not follow instructions well.

7. Does this third party ever notice unusual behavior or fears in you?

8. How does your illness affect your movement, talking, hearing, seeing, and memory?

9. How well are you at completing tasks?

10. How well do you concentrate and understand?

11. Can you follow instructions - verbal and written?

12. How well do you get along with others?

13. Do you handle authority figures well? Have you ever been fired, and if so, why?

14. How well do you handle stress and changes in routine?

Does your illness affect the following and how:

 
lifting
talking
concentration
understanding
following instructions
using hands
squatting
hearing
bending

Do you use any of the following? Were they prescribed? When? When do you use them?

 
 
 
crutches
walker
wheelchair
cane
brace/splint
artificial limb
hearing aid
glasses/contacts
artificial voice box

12. Do you currently take medications? Do they cause side effects? Explain.

Section E gives the third party a chance for REMARKS.

This section is for any information that there wasn't room for elsewhere in the report. Fill this section up. This is an opportunity to express more information that needs to be relayed to the SSA, but was not asked.

Social Security Disability: Function Report – ADULT (Form SSA-3373-BK)

This document will run through pretty much the same questions. This report is not for your third-party. This report is for you to fill out and turn in.

Daily Activities

The questions in this section are the same as the questions in your third party's report in Section B. You may have different answers, but if you are both truthful, there should be similarities in your answers. You will probably have a more thorough idea of what you do in your spare time, your personal care habits, any reminders you use, how social you are, and how you handle your normal everyday chores. The Social Security Administration will want to know how you handle changes in your routine, how you care for others, how you sleep, how you take care of yourself in terms of personal hygiene, what kind of reminders you use, what kind of cooking, chores, and yard work you do, what your shopping habits are, how you handle money, what your hobbies are, and how social you are. They want to know if you can get along with others.

Abilities

These are also the same questions asked of your third party. These are from Section C. You will possibly have more knowledge of your medication and the side effects you experience than your third-party partner does. You may also be more familiar with your movement issues, how you handle stress, and any special aides you need in order to function in a normal way. You should also have a better idea of what jobs you have been fired from, how you handle stress, and how well you get along with authority figures.


The Social Security Administration will most likely compare these two reports to see any consistencies and variances. They want to know how well you function on a daily basis. The SSA is able to tell if you could function in a job, or if you are so disabled that just regular functioning is very difficult for you. Make sure your third party turns his or her report in to the SSA in a timely manner. If the SSA does not receive the report from the third party, they will notify you, so that you may contact the person to ask them to expedite the processing of the report for you. You may need to explain the significance and importance of getting the report turned in on time.

This may be the last report you have to turn in. If so, be relieved! Now, all you have to do is help the Social Security Administration gather up your medical records, and let them make a decision on whether or not you are considered disabled according to the SSA. If they do happen to send you another report to fill out or ask for additional information, complete it as soon as possible, and turn it back in to them. However, ensure that the report or information you send in is accurate and thorough. If you have hired an attorney to help you with your disability, run the report or information by them before submitting it to the SSA.

Comments

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  • misslong123 profile imageAUTHOR

    Michele Kelsey 

    3 years ago from Edmond, Oklahoma

    Thanks. I will check it out.

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