Form SSA-3368 is the basic form used for adult applicants who are filing a claim for disability benefits. This form may require the assistance of a Social Security Disability lawyer. Note that a physician should not complete any portion of this form. There are other forms which the SSA requires a doctor to complete on behalf of an applicant.

The information in Form SSA-3368 is used by the office that renders a decision on a disability claim. Applicants who file an accurate and complete form when first submitted may have their claim decided more expeditiously than those who do not.

  • Section 1 INFORMATION ABOUT THE DISABLED PERSON

This includes contact information (name, address, etc.) and whether the applicant can speak and understand the English language.

  • Section 2 CONTACTS

This is for listing anyone that the SSA may contact who knows about an applicant’s medical condition and may assist the applicant and the SSA with the claim.

  • Section 3 MEDICAL CONDITIONS

This is an important section that requires an applicant to list each medical or mental condition that he or she suffers and how each of these conditions limits the ability to work.

  • Section 4 WORK ACTIVITY

This section details an applicant’s work status and whether he or she is still working or has stopped working. It is important for an applicant to describe in this section how the disability affected and restricted on-the-job performance.

  • Section 6 JOB HISTORY

An applicant must disclose all jobs held over the prior fifteen years, starting with the most recent and then listing the rest in reverse chronological order. This section asks about the type of work performed and how this is answered may strongly affect claim approval.

  • Section 7 MEDICINES

Here, all medications, both prescription and over the counter, even pain relievers, must be listed.

  • Section 8 MEDICAL TREATMENT

This is the longest section on the form. Applicants must list all medical and mental health professionals that are providing or have provided treatment.

  • Section 9 OTHER MEDICAL INFORMATION

This section supplements Section 8.

  • Section 10 VOCATIONAL REHABILITATION, EMPLOYMENT, OR OTHER SUPPORT SERVICES

This only applies if an applicant is already receiving Supplemental Security Income (SSI).

  • Section 11 REMARKS

This section provides applicants with the opportunity to add any additional remarks or statements in support of a claim. An experienced disability attorney may help an applicant complete this section as well as possible so that an applicant has the best possible chance of receiving benefit approval.

An applicant should attach copies of all relevant medical records to Form SSA-3368 when submitting it to the Social Security Administration (“SSA”). An applicant must communicate to the SSA any wish to have these records returned. An experienced and knowledgeable disability attorney may help any applicant accurately complete this and any other form required by the SSA.