Bluebook
SSA Disability Listing Report
1. Intake summary
Diagnoses you selected
None selected.
Symptoms you reported
None selected.
Body regions
None selected.
In your own words
No free-text entry.
2. Top matched SSA listings
No matches yet — fill in the intake page first.
3. Claim scaffold (SSA-3368 mapping)
Section 1 — Identity
| Full name | … |
| Social Security Number | … |
| Date of birth | … |
| Phone | … |
| Mailing address | … |
Section 2 — Medical conditions
No conditions identified.
Section 3 — Work history
| Last job title | … |
| Last employer | … |
| Date stopped working | … |
| Highest annual pay | … |
| Physical demands | … |
Section 4 — Medical treatment
List each treating provider, reason, dates, phone.
Section 5 — Medicines
List each medicine, what it treats, prescriber, side effects.
Section 6 — Tests
List each test, date, place performed.
Section 7 — Education & training
| Highest grade completed | … |
| School / training | … |
| Special education? | … |
Section 8 — Vocational rehabilitation
| Agency | … |
| Contact | … |
| Services received | … |
Section 9 — Remarks
…
4. Sources
This report is a preparation aid generated by Bluebook. It is not legal or medical advice and is not affiliated with the Social Security Administration. The official SSA-3368 form must still be submitted through ssa.gov or your local SSA office. Generated 2026-05-06 06:01 UTC.