Form SSA-3369-BK, Work History Report, is a form used for providing the U.S. Social Security Administration (SSA) with detailed information about all jobs you worked in the past 15 years. The latest version of the form was released on April 1, 2014, with all previous editions obsolete. A fillable Form SSA-3369-BK is available for download below.
The Social Security Work History Report is an important part of your application for Social Security disability benefits. It helps the SSA to obtain detailed information about any employment you had had in the last 15 years before you became unable to work due to an injury, illness, or a particular condition. This document informs the SSA about the type of job you held, specific skills and experience you gained, and the mental and physical requirements that each of the positions demanded. The agency needs these details to make sure that you can no longer perform the duties you performed on your previous jobs, and have no skills or knowledge to find work in any other area.
The information you provide via this form is used to make a decision on your disability request. Follow all the instructions to prevent protracting your disability claim decision:
You can find detailed SSA Form 3369-BK instructions on the first two pages of the form. Read them carefully, detach them, and keep them for reference. If you need help when completing the form, fill it out as much as you can and call the support phone number sent to you with the form. You can also ask your lawyer or attorney to help you.
Return the filled-out Form SSA-3369-BK to the state agency that requested it. If you cannot find the envelope with your state agency address, call the SSA at the phone number indicated on the second page of the form.