OMB control number
Report of Adult Functioning-Employer
OMB 0960-0805 · SSA.
Under the authority provided in sections 205(a), 223(d)(5)(A), 1631(d)(1), and 1631(e)(1) of the Act, the agency may collect information from each applicant for, or recipient of (collectively referred to as ‘‘claimant’’), disability insurance benefits (DIB) or SSI payments. We use this information as evidence to help us determine eligibility or continued eligibility for DIB or SSI. These sections of the Act grant us the authority to establish procedures for collecting and verifying this evidence. Sections 20 CFR 404.1512 and 20 CFR 416.912 of the Code of Federal Regulations provide detailed requirements for the types of evidence we request claimants provide showing how their impairment(s) affects their ability to work (e.g., medical, work experience, daily activities, efforts to work). When SSA’s Disability Determination Service adjudicative team determines that SSA needs additional information to process an applicant’s or claimant’s case, we use Form SSA-3385, Report of Adult Functioning – Employer, to collect information from a claimant’s current or former employer on an as needed basis, to collect information regarding the claimant’s job performance as evidence to help inform the disability eligibility for the claimant. We send the SSA-3385 with a pre addressed and stamped envelope to a claimant’s direct supervisor, or another person who has direct knowledge of the claimant’s job performance and ask that individual to provide information about the claimant’s day-to-day functioning in a work setting. The respondent completes Form SSA-3385 and sends it back to SSA in the enclosed envelope. Once SSA receives the SSA-3385, the field office scans the form into the claimant’s electronic folder. Then the Disability Determination Service adjudicative team uses this information to evaluate the claimant’s impairment-related functional limitations to determine eligibility or continued eligibility for SSDI or SSI. The respondents are current or former employers who are contacted only when the adjudicative team decides additional information is necessary and the employer may be a good source for the information. We are submitting this non-substantive change to remove the signature line and replace the Penalty of Perjury Statement with a Penalty of Perjury Warning.
The latest form for Report of Adult Functioning-Employer expires 2026-08-31 and can be found here.
Document Name |
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Form |
Form |
Justification for No Material/Nonsubstantive Change |
Justification for No Material/Nonsubstantive Change |
Justification for No Material/Nonsubstantive Change |
Justification for No Material/Nonsubstantive Change |
Supporting Statement A |
Supporting Statement A |
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Approved without change |
No material or nonsubstantive change to a currently approved collection | 2024-04-26 | |
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Approved without change |
No material or nonsubstantive change to a currently approved collection | 2024-02-22 | |
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Approved with change |
Revision of a currently approved collection | 2022-10-21 | |
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Approved without change |
Revision of a currently approved collection | 2019-09-27 | |
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Approved without change |
No material or nonsubstantive change to a currently approved collection | 2018-11-23 | |
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Approved without change |
No material or nonsubstantive change to a currently approved collection | 2017-07-12 | |
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Approved without change |
New collection (Request for a new OMB Control Number) | 2016-07-19 |