Fill Out Form SSA-3369-BK Online in 2026

Form SSA-3369-BK, known as the Work History Report, is essential for the Social Security Administration (SSA) to assess your work history over the past 15 years. This form gathers vital details about each job you’ve held, including your job duties, tools you used, and any supervisory roles you've taken on. Accurate completion of this form is crucial for determining your eligibility for disability benefits and is typically required after you submit your disability application. Both you and your representative can fill it out.

Form SSA-3369-BK, also known as the Work History Report, is an important document for social security claims. It is used for the following purposes:

• List jobs: To record all jobs held in the five years before the claimant became unable to work due to health issues.
• Detail work history: To provide specific details about each job, including dates, duties, limitations, and daily activities.
• Assess disability claims: To assist in evaluating eligibility for Social Security Disability benefits based on work history and limitations.

1. Enter your name, Social Security number, and daytime telephone number in Section 1.

2. List all jobs from the last 5 years in Section 2, including job title, company type, and dates.

3. Provide any additional information in Section 3, including extra job details if necessary.

4. Identify who is completing the form in Section 4 and include their contact information.

5. Attach any supplementary forms if needed, marking them accordingly.

Individuals applying for Social Security Disability benefits and their representatives are responsible for completing Form SSA-3369-BK.

The Social Security Administration uses this form to evaluate a claimant's work history and daily activities, aiding in the assessment of their ability to work and the determination of disability benefits.

Form SSA-3369-BK, Work History Report, is not required if you haven’t worked in the last 15 years while applying for SSDI or SSI. If your disability claim relies only on medical records, you also do not need this form. Additionally, if you are homeless, difficult to contact, or unavailable during the application process, skip this form.

Form SSA-3369-BK is due by the deadline specified in the letter you receive from the Social Security Administration (SSA) or Disability Determination Services. According to official SSA procedures, you typically have 10 days from the date on the letter requesting the form to complete and return it. Always refer to the specific instructions and due date provided in your SSA or DDS correspondence to avoid delays in your disability claim process.

To obtain a blank Form SSA-3369-BK, issued by the Social Security Administration (SSA), you can visit our website. We have this form pre-loaded in our editor, allowing you to fill it out and download it. Remember, our platform assists in filling and downloading but does not handle filing forms.

No, you do not need to sign Form SSA-3369-BK. Official sources indicate that neither the paper nor the electronic version of this form requires a signature. However, it’s always a good idea to check for the latest updates. Once you fill out the form using CookPDF, you can download it for your records, but keep in mind that CookPDF does not support submission of forms.

Form SSA-3369-BK must be submitted by mail or delivered to your local Social Security office. Online filing is not an option.

For assistance, reach out to your local Social Security office. They can provide specific instructions for your submission.