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Keefe Disability Law
Social Security Disability & Supplemental Security Income
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What is the Activities of Daily Living questionnaire?


The Social Security Administration wants to know if your disability prevents you from working. In order to make this critical assessment that will significantly impact your Social Activities of Daily Living Questionnaire and Social Security Disability BenefitsSecurity disability eligibility, the Social Security Administration (SSA) may ask that you fill out an Activities of Daily Living Questionnaire.

The purpose of the questionnaire is to better assess how your physical and mental impairments impact your daily life. While your medical records allow the SSA to evaluate your medical diagnoses, this questionnaire allows them to assess how the diagnoses impact your life on a day-to-day basis. Your answers will help determine whether you have functional limitations that impact your ability to engage in substantial gainful activity. Learn more about substantial gainful activity in our other article.

What Is Included in the Activities of Daily Living Questionnaire?

The Activities of Daily Living Questionnaire is more formally known as Function Report – Adult – Form SSA-3373-BK. This form asks about your abilities and limitations in performing tasks such as caring for yourself and your household.

Some of the questions that you can expect on the form include:

  • Do you live alone or with other people?

  • How does your disability limit your ability to work?

  • What do you do on a typical day, starting from the time you wake up until the time you go to bed?

  • Do you take care of other people—such as children, a spouse, parents, other relatives, or pets? What do you do for them? Do you have any help from anyone else?

  • What were you able to do before you became disabled that you cannot do now?

  • Does your disability affect your sleep?

  • Does your disability affect your ability to get dressed, bathe yourself, shave, use the toilet, or otherwise take care of yourself?

  • Do you need help or reminders to take medication?

  • Do you prepare your own meals?

  • Are you able to do household chores? Are there any household chores that you need help with?

  • How often do you go outside?

  • Do you drive?

  • Can you go out alone?

  • Can you shop? Can you do it independently?

  • Are you able to pay your own bills and manage your own money?

  • Do you have hobbies, interests, and activities that you enjoy on a regular basis?

  • Do you spend time with others? In what situations? Do you have trouble getting along with people?

  • What abilities does your disability impact? Examples include lifting, walking, concentrating, using hands, talking, sitting, and other important abilities.

  • How far can you walk before you need to rest?

  • How long can you pay attention?

  • Do you finish what you start?

  • Can you follow verbal or written instructions?

  • Do you get along with authority figures?

  • Have you ever been fired because you had trouble getting along with others?

  • How well do you handle stress and changes in routine?

  • Do you use any assistive devices (such as hearing aids or crutches, for example)?

  • Do you take any medications? What are the side effects of those medications?

If you answer yes, or in such a way as to indicate that you are disabled, then you will be asked to further explain your limitations or condition in a short answer format. Additionally, there is space at the bottom of the questionnaire for you to add in information that was not included in the routine questions.

Tips for Completing the Activities of Daily Living Questionnaire

The good news is that you are the person in the best position to answer questions about what you do on a typical day. When you complete the form it is important to:

  • Be honest. You do not want to exaggerate or understate your limitations and abilities.

  • Give as many details as you can so that the person reading the questionnaire gets an accurate idea of what your life is like on a daily basis.

Technically, this form is voluntary. However, if you fail to fill it out, then the SSA may not be able to find you eligible for Social Security disability benefits. While you are the one who must fill out the form, it should be done in consultation with your Social Security disability lawyer who can help you complete your entire Social Security disability application.

For more information, or to get started with your own Social Security disability claim, please contact us today via this website or by phone to schedule your initial consultation. Additionally, we encourage you to download a FREE copy of our book, Unlocking the Mystery: The Essential Guide for Navigating the Social Security Disability Claims Process, to learn more today.


John L. Keefe
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Founding Attorney of Keefe Disability Law