Disability Report - Adult

OMB 0960-0579

State Disability Determination Services (DDS) use the SSA-3368 and its electronic versions to determine if an adult disability applicant's impairment(s) is severe and, if so, how the impairment(s) affects the applicant's ability to work. This determination dictates whether the DDSs and SSA will find the applicant to be disabled. Therefore, the information the DDSs collect on this form is crucial in making disability determinations for all adult claimants filing for SSA disability benefits or Supplemental Security Income (SSI) payments. The respondents are applicants for Title II disability benefits or Title XVI SSI payments.

The latest form for Disability Report - Adult expires 2021-11-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form SSA-3368 Disability Report - Adult, (Fillable PDF) Form and Instruction
Addendum - 0579 (Final).docx Supplementary Document
Supporting Statement - 0579 (Final).docx Supporting Statement A
Disability Report - Adult, (Fillable PDF) Form and Instruction
Disability Report - Adult, (Internet Version) Other-i3368 (Internet)
Disability Report - Adult (EDCS Version) Other-EDCS

All Historical Document Collections

202104-0960-011	Revision of a currently approved collection	2021-10-29
201803-0960-006 Approved without change	Revision of a currently approved collection	2018-07-30
201504-0960-003 Approved without change	Revision of a currently approved collection	2015-07-01
201501-0960-004 Approved without change	No material or nonsubstantive change to a currently approved collection	2015-01-12
201311-0960-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2013-11-11
201302-0960-004 Approved without change	No material or nonsubstantive change to a currently approved collection	2013-02-28
201205-0960-003 Approved without change	Revision of a currently approved collection	2012-08-13
201104-0960-006 Approved without change	No material or nonsubstantive change to a currently approved collection	2011-04-08
200904-0960-012 Approved without change	Revision of a currently approved collection	2009-07-31
200901-0960-007 Approved without change	No material or nonsubstantive change to a currently approved collection	2009-01-22
200708-0960-002 Approved with change	Revision of a currently approved collection	2007-08-02
200704-0960-003 Improperly submitted and continue	Revision of a currently approved collection	2007-07-24
200608-0960-012 Approved without change	No material or nonsubstantive change to a currently approved collection	2006-08-24
200412-0960-011 Approved without change	Revision of a currently approved collection	2004-12-28
200402-0960-011 Approved without change	No material or nonsubstantive change to a currently approved collection	2004-02-17
200309-0960-007 Approved without change	Revision of a currently approved collection	2003-09-08
200210-0960-008 Approved with change	Revision of a currently approved collection	2002-10-21
200106-0960-002 Approved without change	Revision of a currently approved collection	2001-06-01
199806-0960-002 Approved without change	Reinstatement with change of a previously approved collection	1998-06-02
199707-0960-009 Approved without change	New collection (Request for a new OMB Control Number)	1997-07-23

OMB Details

Disability Report - Adult, (Fillable PDF)

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Form SSA-3368

Disability Report - Adult

Fillable Printable

Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.