How to Fill out Form SSA-3369

Form SSA-3369 is the “Work History Report” required by the Social Security Administration (SSA) as an essential component of an application for Social Security Disability (SSD) benefits. This form asks for previous positions of employment, including job titles and the dates that you worked in each position, going back 15 years from the time that your disability became so severe that it prevented you from working.

The Work History Report also asks for specific details about each job on your employment history list. Specifically, the form will ask for details about the kind of work you performed and the physical requirements of each job, like the how much weight you were required to lift and how frequently you had to walk, stand, push, pull, or stoop, for example.

Why Form SSA-3369 is Important

The information requested on form SSA-3369 is intended to help the SSA determine how your medical condition affects your ability to work in jobs for which you’re qualified. The report shows the SSA the type of work you’ve done in the past and the job skills and experience you’ve gained over the course of your employment. It also tells the SSA the type of mental and physical requirements of each of the positions you held in the past, giving insight into what kind of job duties you were once able to perform.

While the details that appear on the Work History Report are crucial in the disability eligibility determination process, they are not the only details the SSA will take into account when making a decision on your disability claim. Form SSA-3369 helps establish whether you’re able to perform any kind of gainful work for which you may be qualified.

In other words, the details on the form are necessary for the SSA to not only see that you can no longer work in the last job you held but also that you don’t have the knowledge, skills or experience to find work in another area of the workforce in which your medical condition and the limitations it imposes on you would not prevent you from performing essential job functions.

How to Complete Form SSA-3369

When completing the SSA-3369 form, you should ensure you answer all questions, leaving no sections of the form blank. In areas where questions are not applicable in your case or where you’re not sure of the answer, you should indicate as much by answering “I don’t know” or “does not apply”.

Leaving a question blank will leave the SSA with more questions that must be answered before they can make a decision on your eligibility to receive SSD benefits. By ensuring you answer every question to the best of your ability, you potentially shorten your wait for a decision on your eligibility.

Any question on the form that asks for a more detailed explanation, like the questions on “lifting and carrying”, for instance, should be thoroughly answered. Be sure to provide an explanation whenever you’re asked to do so.

If you need to provide further explanation of any other answers to standard questions on the form, you may do so in the “remarks” section, which appears toward the end of form SSA-3369. However, you may wish to consult with a Social Security advocate or attorney before deciding what information to include in the remarks section of the form to make sure the details you provide are relevant and truly represent your physical, mental or other limitations.