The Forms SSA-3368-BK (Disability Report – Adult), SSA-3441-BK (Disability Report – Appeal), and SSA-454-BK (Disability Report – Continuing Disability Review) provide the Disability Determination Services (DDS) with the information needed to make a disability determination, such as a detailed explanation of the claimant's medical information, functional abilities, and any work history.

Field office (FO) interviewers or reviewers must ensure that information documented on forms that are designated as the FO's responsibility (see DI 11005.018) is as complete and accurate as possible. Discrepancies in information contained in the file should be resolved before the claim is transferred to the DDS (e.g., reports of different dates last worked on the SSA-3368 and SSA-3369).

Use the following guidelines 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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  When no items are checked in questions requesting that the claimant check items on a list, ask the claimant if they overlooked the question. If the question was intentionally left 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.