Form ssa 1372 bk question 5-2026

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  1. Click ‘Get Form’ to open the SSA 1372 BK in the editor.
  2. Locate question 5, which typically asks for specific information regarding your circumstances. Carefully read the instructions provided to ensure you understand what is required.
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Social Security uses the ADL questionnaire form to find out exactly how an impairment affects your behavior and activities. The agency then uses that information to determine if youre capable of participating in substantial gainful activity (SGA).
Be Specific on Question 5 Here are some examples of what you could include in this section of the SSD Function Report: I could no longer type on a keyboard or write memos. I could not lift and carry (my tools or supplies), and I often dropped (things). My job required a lot of walking, which I can no longer do.
It is important to complete the SSA-3373 in the applicants own words. Describe their struggles on their worst days. Help the applicant to describe specific scenarios using open-ended questions. Always expand on the Yes/No answers with more detailed explanations.

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The Adult Function Report is often used by Social Security to discredit your claim. The ten-page form asks about your daily activities, personal care, meal prep, household and yard work, hobbies, and social activities.
Third Party Adult Function Report is a form that Social Security sometimes send to your contact person. This form is usually sent out two or three months after you first apply. It is also sometimes used during Continuing Disability Reviews, for people who are already on disability.
Functional Reporting gathers data on beneficiaries functional limitations during the therapy episode of care as reported by therapy providers and practitioners furnishing physical therapy (PT), occupational therapy (OT) and speech-language pathology (SLP) services.

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