Use this to draft answers, then transfer to the official form. Bluebook does not file with SSA.
A. Information about you
Living situation
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A typical day from waking up to going to bed
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B. Personal care
Dressing
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Bathing
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Hair care
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Shaving / makeup
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Feeding yourself
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Using the toilet
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C. Daily living
Meal preparation
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Housework / yard work
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Getting around
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Shopping
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Handling money
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D. Hobbies & social
Hobbies and interests
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Social activities
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E. Physical & mental abilities
Lifting
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Standing
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Walking
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Sitting
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Climbing
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Kneeling / squatting
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Concentration
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Memory
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Following instructions
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Stress / change
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F. Overall impact
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Generated by Bluebook. Maps to the Adult Function Report, SSA-3373. Submit the official form to SSA. Bluebook is not affiliated with the Social Security Administration.