Report of Adult Functioning-Employer

OMB 0960-0805

OMB 0960-0805

Individuals receiving or applying for Social Security Disability Insurance or SSI provide SSA with medical evidence and other proof SSA requires to prove their disability. Past employers familiar with the claimant’s ability to perform work activates complete Form SSA-3385-BK, Report of Adult Functioning-Employer, to provide SSA with information about the employee’s day-to-day function in the working setting. We only reach out to past employers when the adjudicative team decides more information is necessary, and that they would be a good source for that information. SSA and Disability Determination Services (DDS) use the information Form SSA-3385-BK collects as a basis to determine eligibility or continued eligibility for disability benefits. The respondents are claimants’ past and current employers.

The latest form for Report of Adult Functioning-Employer expires 2022-12-31 and can be found here.


© 2024 OMB.report | Privacy Policy