Sample Questions: Disability Benefits and Daily Activities

Background and General Description

  • Do you live in an apartment, a house, a duplex, a condo, a mobile home?
    • Does your house have one story or two?
    • Is your bedroom upstairs or downstairs?
    • How many rooms?
  • What do you do on an average day?
  • Describe your day for us from the time you get up in the morning until you go to bed at night.
  • Give us some examples of things you do differently now than you used to do.

Activities of Daily Living

How are the following things handled at your house?

  • Cooking.
  • Doing the dishes.
  • Grocery shopping.
  • Cleaning.
  • Dusting.
  • Straightening up.
  • Taking out the garbage.
  • Making beds.
  • Changing bed sheets.
  • Vacuuming.
  • Floor mopping.
  • Bathroom cleaning.
  • Laundry.
  • Watching children.
  • Yard work.
  • Grass cutting.
  • Gardening.
  • Snow shoveling.
  • Home repairs.
  • Paying bills/handling finances.
  • Going to the post office.
  • Taking public transportation.
  • Obtaining a telephone number from phone directory or directory assistance.

Social Functioning and Leisure Activities

  • How often do you visit:
    • Family members?
    • Friends?
    • Neighbors?
  • Do you initiate contacts or do they?
  • Do you have any problem getting along with:
    • Family?
    • Friends?
    • Neighbors?
    • Store clerks?
    • Landlords?
    • Bus drivers?
  • How often do you go to church?
  • Do you participate in any organizations?
  • Do you play cards? Other games?
  • Do you attend sports events?
  • Do you go to movies?
  • Do you go out to eat?
  • Do you have any hobbies?
  • How often do you read the newspaper
  • Do you watch television news programs?
  • Do you keep up with current events?

Personal Care

  • Do you have any problem, need any assistance or reminders with:
    • Dressing?
    • Buttoning clothes?
    • Tying shoelaces?
    • Bathing?
    • Combing/fixing hair?
    • Shaving?
  • Do you get dressed every day?

Examples of Limited Activities

  • How much time do you spend daily doing the following:
    • Sitting in your favorite chair? Describe the chair.
    • Watching television?
    • Reading?
    • Talking on the telephone?
    • Sleeping?
    • Lying down?
  • Where do you go to lie down (e.g., bed, couch, recliner)?
  • How often do you drive a car?
  • How often do you go out of the house?
  • When you begin a household task, do you complete it in a timely manner? If not, give examples.
  • Are there any hobbies you have been forced to give up because of your impairment?

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