Effective Dates: 09/22/2026 - Present Previous | Next

TN 140 (09-26)

DI 11005.022 Completing and Reviewing Interview Forms

A. Disability interview forms

The disability report forms (e.g., SSA-3368 (Disability Report Adult)) provide the Disability Determination Services (DDS) with information needed to make a disability determination, such as a detailed explanation of the claimant's medical information, functional abilities, and any work history. In the disability interview process, a Field Office (FO) interviewer may assist the claimant to complete these forms before case transfer to the DDS.

NOTE:When the Electronic Disability Collect System (EDCS) establishes an EDCS 3368 for a case with the "Homeless" flag, the system displays the message “Complete forms SSA-3373 (Function Report – Adult) and SSA-3369 (Work History Report) prior to transfer for homeless cases. Refer to DI 11005.026 and DI 11005.025." At case creation, EDCS automatically adds the "Homeless" flag when the claimant's address includes certain keywords, e.g.:

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    General Delivery

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    Homeless

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    No Address

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    None

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    Shelter

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    Transient

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    Unknown

For more information on how to identify a potential homeless case, see DI 11005.004.

B. Responsibilities for completing disability reports

FO interviewers or reviewers must ensure that information documented on the disability report (and other forms that are designated as the FO's responsibility in DI 11005.018) is as complete and accurate as possible. For more information on the responsibility to ensure all items and questions have been completed to the extent possible, see DI 11005.040.

FO interviewers and reviewers also resolve discrepancies in information contained in the file before the claim transfers to the DDS (e.g., reports of different dates last worked on the EDCS 3368 and SSA-3369).

NOTE: In general, the disability report and SSA-827 (Authorization to Disclose Information to the Social Security Administration) are required to transfer an initial claim to the DDS. For instructions on when to transfer a claim in EDCS, see DI 81010.085.

C. Procedures to complete and review disability reports

In general, when completing and reviewing the claimant's forms:

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    Every applicable question should be answered as completely and accurately as possible.

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    Enter “NA” when a question does not apply.

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    Addresses, including ZIP codes and telephone numbers, including area codes, must be complete, unless a regional or local arrangement with the DDS permits a partial entry or a coded annotation in the medical source items.

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    For questions requesting a “Yes” or “No” answer, be sure the applicant checked one of the blocks or explained why neither was appropriate, and provided an explanation when appropriate.

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    If no item is checked in questions requesting that the claimant check items on a list, ask the claimant whether the question was overlooked. If the claimant intentionally left the question blank, enter “N/A”.

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    Where we ask for a narrative response, or one would be appropriate, the claimant should provide a thorough and complete explanation.

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    Use the Remarks section to provide further explanation of any answers, elaborate on sources listed, or supply additional sources of evidence.

NOTE: Carefully review the forms for indications of work activity or receipt of other disability benefits (e.g., workers compensation) that may affect the claim. For FO responsibilities in work development, see instructions in DI 11010.140A. For FO responsibilities in workers compensation and public disability benefits (WC/PDB) development, see instructions in DI 52140.001.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0411005022
DI 11005.022 - Completing and Reviewing Interview Forms - 09/22/2026
Batch run: 09/22/2026
Rev:09/22/2026