Function Report - Adult

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-3373 Function Report -- Adult	Form and Instruction	Modified	Available
Form SSA-3373 Function Report -- Adult	Form and Instruction	Modified	Available
Addendum - 0681.docx	Supplementary Document	Uploaded 2026-09-25	Available
Supporting Statement - 0681 (Final).docx	Supporting Statement A	Uploaded 2026-09-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9735	Function Report - Adult	Form and Instruction	Modified	Function Report -- Adult
9735	Function Report - Adult	Form and Instruction	Modified	Function Report -- Adult
9735	Function Report - Adult	Other-Revised PA Statement	Modified

ICR Details

OMB Control No: 0960-0681	ICR Reference No: 202609-0960-004
Status: Received in OIRA	Previous ICR Reference No: 202104-0960-006
Agency/Subagency: SSA	Agency Tracking No:
Title: Function Report - Adult
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 09/28/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	09/30/2026
Responses	1,812,929	1,734,635
Time Burden (Hours)	3,233,057	2,630,863
Cost Burden (Dollars)	0	0

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Abstract: SSA requires individuals applying for or receiving SSDI or SSI benefits to provide us with medical evidence and other information we may need to prove their disability. SSA staff, and State DDS employees on SSA’s behalf, use Form SSA 3373, an in-person interview, or a telephone interview to collect information directly from an adult SSI or SSDI claimant or recipient about how their purported disability affects their activities, capabilities, and general ability to function. We use this information to help determine eligibility, or continued eligibility, for SSI and SSDI claims. The respondents are adult Title II and Title XVI claimants, or current recipients undergoing redeterminations of benefits.

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Authorizing Statute(s): US Code: 42 USC 1383 Name of Law: Social Security Act
   US Code: 42 USC 405 Name of Law: Social Security Act
   US Code: 42 USC 423 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 48470	07/31/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 60677	09/24/2026
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Function Report - Adult	SSA-3373, SSA-3373	Function Report -- Adult ,   Function Report -- Adult

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ICR Summary of Burden

table that charts list of burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,812,929	1,734,635	0	0	78,294	0
Annual Time Burden (Hours)	3,233,057	2,630,863	0	0	602,194	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: When we cleared the this ICR in 2023, the burden was 1,763,546 hours. However, we are currently reporting a burden of 1,843,144 hours. The increase in burden is due to an increase in the number of responses from 1,734,635 to 1,812,929. These figures represent current Management Information data. *Note: The total burden reflected in ROCIS is 3,233,057, while the burden cited in #12 of the Supporting Statement is 1,843,144. This discrepancy is because the ROCIS burden reflects the following components: field office waiting time + telephone call system wait times + a rough estimate of a 30-minute, one-way, drive burden. In contrast, the chart in #12 above reflects actual burden.

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Annual Cost to Federal Government: $21,919,234

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/28/2026

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