The Adult Disability Report (ADR) is one of several forms you're required to complete when you file an application for Social Security disability benefits. Made up of eleven sections over almost fifteen pages, the ADR asks for detailed information about your education, work history, and medical treatment. Social Security uses the information provided on the ADR to decide whether you are disabled at the application stage.
Before You Start the Adult Disability Report
The Adult Disability Report (SSA Form 3368-BK) can be completed in paper format or online (if you file online, you'll find it is now included with the main disaiblity application). Whichever you prefer, there are a few things you should do before you begin.
Read the attached instructions carefully. The instructions contain the following useful bits of information; among others:
- You may ask for help from a friend or family member to complete the form. Social Security representatives are also available to assist you if necessary.
- Answer every question on the form, and write "don't know," "none," or "does not apply" where appropriate. Leaving questions blank could delay the processing of your application.
- If you need more space for your response to a question, use Section 11 - Remarks. Be sure to write the number of the question you're answering.
- You do not need to request your own medical records. Social Security will obtain your records using the treatment information you provide on the ADR.
Gather documents related to your medical and vocational history. Many of the questions on the ADR ask for specific information you probably won't know off the top of your head, like dates, addresses, phone numbers, and medications. Collecting your important records before you begin will save you lots of time and headache.
Completing the Adult Disability Report
It usually takes a disability applicant at least a few hours to complete the ADR, so you may want to complete it in sections and return to it at your convenience. If you're filling it out online, you'll receive a "re-entry number" so that you can save your work and return to it later.
Sections 1 and 2: Background and Third-Party Information
The first section of the report asks for your contact information, language preference, and any other names you've used in the past. The next section asks for the contact information of a friend or family member who knows about your medical situation and can help with your case. Social Security will send this person a Third-Party Report to get his or her impressions of your day-to-day limitations, so make sure the person you list has the knowledge and willingness to assist with your claim.
Section 3: Medical Conditions
Here you'll list all the physical and mental limitations that keep you from working. Even if you haven't received much or any treatment for a particular condition, it's a good idea to include it. Social Security will consider all your impairments, both severe and non-severe, in determining whether you're disabled, so be sure to list even conditions such as high blood pressure that might not prevent you from working by themselves. If you need more space to list your medical conditions, continue your answer in Section 11 - Remarks.
Section 4: Work Activity
This section deals with your current and past work activity, and asks you to establish the onset date of your disability. If you had to stop working or make changes in your work activity due to your medical condition, be sure to mark this box on the form and give an explanation. For example, if medical issues forced you to reduce your hours work, take a lesser-paying job, or leave the job entirely, you should mention it.
Choosing a disability onset date can present challenges, as it's often difficult for individuals to know on precisely what date they became unable to work. Many people choose the last date they worked, or the date of a major medical event such as an accident or an operation. You should try to pick the earliest date possible that is supported by the medical evidence. If you need to adjust the disability onset date before your hearing, you or your attorney can always amend it.
Section 5: Education and Training
When marking your education level in Section 5, be sure to indicate the highest grade you completed, not the highest you attended. It sounds like a small distinction, but the issue of whether you finished twelfth grade or eleventh grade can make all the difference in a case.
Section 6: Job History
Starting with your most recent job, list any work you've done in the past 15 years. If you don't remember the dates you worked, your hours, or your rate of pay, you can try to contact former employers or look at past pay stubs. SSA is not expecting laser precision here, so do the best you can.
If you've had only one job in the past 15 years, you'll be asked for more information about that position, including its physical demands. One question asks if you hired and fired employees. Unless you were solely in charge of hiring and firing, answer no. Another question asks if you were a "lead worker," which SSA defines as an employee who plansand coordinates work, and trains and guides others while performing that work as well. Most employees are not lead workers; if you're unsure, answer no.
Sections 7 and 8: Medicines and Medical Treatment
Section 7 asks for the names of all your medications, both prescription and over-the-counter, the reasons for your medication, and the doctors prescribing them. If you're unsure of the reason, simply write "unsure." You can usually obtain a list of your current and previous medications from your pharmacy.
Section 8, which deals with your medical treatment, is the most extensive and time-consuming part of the ADR. It asks for the names and contact information of any physicians, clinics, or hospitals where you've received treatment, as well as the dates of treatment. Social Security uses this information to request your medical records, so be as accurate and complete as you can. Don't forget to include mental health treatment as well.
Section 9: Other Medical Information
List any other facility that might be in possession of records related to your physical or mental condition, such as insurance companies, prisons, or vocational rehabilitation agencies.
Section 10: Vocational Rehabilitation, Employment, or Other Support Services
You need to complete this section only if you're already receiving Supplementary Security Income (SSI).
Section 11: Remarks
Use this section to finish any answers from the first ten sections, or to provide other relevant information that you haven't already mentioned.
How to Get Help With the ADR
You may want to consult an experienced disability attorney for help with your Adult Disability Report, as your answers can greatly impact your chances of a successful claim.