The disability report forms SSA-3368-BK (Disability Report – Adult), SSA-3441-BK (Disability Report – Appeal), and SSA-454-BK (Continuing Disability Review Report) 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. Field Office (FO) interviewers assist claimants in completing these forms during the disability interview process before transferring the case to the DDS.

FO interviewers or reviewers must ensure that information documented on the disability report and other forms that are designated as the FO's responsibility (see DI 11005.018) is as complete and accurate as possible.

FO interviewers and reviewers should resolve discrepancies in information contained in the file before the claim is transferred to the DDS (e.g., reports of different dates last worked on the SSA-3368-BK and SSA-3369-BK (Work History Report)).

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 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.