What is Form SSA-3369-BK?
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.
What is Form SSA-3369-BK used for?
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.
How to fill out Form SSA-3369-BK?
- 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.
Who is required to fill out Form SSA-3369-BK?
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.
When is Form SSA-3369-BK not required?
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.
When is Form SSA-3369-BK due?
The deadline for Form SSA-3369-BK, Work History Report, is when you apply for Social Security Disability benefits. The specific deadline is set by the Social Security Administration (SSA) at the time of application. To prevent any delays in processing your application, it’s important to submit this form promptly. Always refer to the SSA's instructions for precise deadlines.
How to get a blank Form SSA-3369-BK?
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.
Do you need to sign Form SSA-3369-BK?
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 PDF Guru, you can download it for your records, but keep in mind that PDF Guru does not support submission of forms.
Where to file Form SSA-3369-BK?
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.
