Form SSA-3368-BK (06-2020) UF Page 2 of 15
WHAT WE MEAN BY "DISABILITY"
“Disability” under Social Security is based on your inability to work. For purposes of this claim, we want you
to understand that “disability” means you are unable to work as defined by the Social Security Act. You will
be considered disabled if you are unable to do any kind of work for which you are suited and if your
disability is expected to last (or has lasted) for at least a year or is expected to result in death. So when we
ask “when did you become unable to work,” we are asking when you became disabled as defined by the
Social Security Act.
Privacy Act Statement
Collection and Use of Personal Information
Section 205(a), 223(d), 1614(a), and 1631 of the Social Security Act, as amended, allows us to collect this
information. Furnishing us this information is voluntary. However, failing to provide all or part of the
information may prevent an accurate and timely decision on any claim filed.
We will use the information to determine eligibility for benefits. We may also share your information for the
following purposes, called routine uses:
• To contractors and other Federal agencies, as necessary and other Federal agencies, as
necessary, for the purpose of assisting the Social Security Administration (SSA) in the efficient
administration of its programs; and
• To applicants, claimants, prospective applicants or claimants, other than the data subject, their
authorized representatives or representative payees to the extent necessary to pursue Social
Security claims and to representative payees when the information pertains to individuals for whom
they serve as representative payees, for the purpose of assisting SSA in administering its
representative payment responsibilities under the Act and assisting the representative payees in
performing their duties as payees, including receiving and accounting for benefits for individuals for
whom they serve as payees.
In addition, we may share this information in accordance with the Privacy Act and other Federal laws. For
example, where authorized, we may use and disclose this information in computer matching programs, in
which our records are compared with other records to establish or verify a person's eligibility for Federal
benefit programs and for repayment of incorrect or delinquent debts under these programs.
A list of additional routine uses is available in our Privacy Act Systems of Records Notice (SORN) 60-0089,
entitled Claims Folders Systems, as published in the Federal Register (FR) on April 1, 2003, at 68 FR
15784, and 60-0320, entitled Electronic Disability Claim File, as published in the FR on December 22, 2003,
at 68 FR 71210. Additional information, and a full listing of all of our SORNs, is available on our website at
www.ssa.gov/privacy.
AFTER COMPLETING THIS REPORT, REMOVE THIS SHEET AND KEEP IT FOR YOUR RECORDS
Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. §
3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these
questions unless we display a valid Office of Management and Budget control number. We estimate that it
will take about 90 minutes to read the instructions, gather the facts, and answer the questions. SEND OR
BRING THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. You can find your
local Social Security office through SSA's website at www.socialsecurity.gov. Offices are also listed
under U. S. Government agencies in your telephone directory or you may call Social Security at
1-800-772-1213 (TTY 1-800-325-0778). You may send comments on our time estimate above to: SSA,
6401 Security Blvd, Baltimore, MD 21235-6401. Send only comments relating to our time estimate to
this address, not the completed form.