OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Function Report - Adult Third Party

OMB 0960-0635 ยท SSA.

OMB 0960-0635

Individuals receiving or applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) provide SSA with medical evidence and other proof SSA requires to prove their disability. SSA, and Disability Determination Services (DDS) on our behalf, collect this information using Form SSA-3380-BK. We use the information to document how claimant's disabilities affect their ability to function, and to determine eligibility for SSI and SSDI claims. The respondents are third parties familiar with the functional limitations (or lack thereof) of claimants who apply for SSI and SSDI benefits.

The latest form for Function Report - Adult Third Party expires 2026-09-30 and is listed under ICR 202110-0960-003.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form SSA-3380 Function Report - Adult Third PartyForm and Instruction
Addendum 0635.docx Supplementary Document
Supporting Statement - 0635 (Final).docxSupporting Statement A
Function Report - Adult Third Party Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202110-0960-003 Revision of a currently approved collection 2021-11-01 Approved with change
201805-0960-013 Revision of a currently approved collection 2018-08-20 Approved without change
201504-0960-013 Revision of a currently approved collection 2015-08-13 Approved without change
201206-0960-007 Revision of a currently approved collection 2012-09-27 Approved without change
200905-0960-007 Revision of a currently approved collection 2009-07-31 Approved without change
200708-0960-017 Revision of a currently approved collection 2008-05-30 Approved without change
200608-0960-004 Revision of a currently approved collection 2006-08-18 Approved without change
200407-0960-002 Revision of a currently approved collection 2004-07-09 Approved without change
200109-0960-027 No material or nonsubstantive change to a currently approved collection 2001-09-28 Approved without change
200106-0960-001 New collection (Request for a new OMB Control Number) 2001-06-01 Approved without change