Tips in Completing the Work History Report (SSA 3369-BK)
As part of SSA’s disability determination process, SSA will evaluate an individual’s (Claimant) work history to determine whether a Claimant can return to a Claimant’s past work or has skills that are transferrable to other work. SSA will evaluate the Claimant’s “Past Relevant Work (PRW)” for the last 15 years.
In SSA’s assessment of a Claimant’s past work, SSA will require a Claimant to complete a Work History Report (Form SSA 3369-BK). The Work History Report is very important to the disability determination process and the Claimant should take care and time in completing the form.
Tip 1: On page 1 of the Work History Report, the Job Title/Type of Business for each job held should be listed in chronological order with the most recent Job Title/Type of Business first. (Note: some people have had several job titles within the same business. Each Job Title held by the Claimant needs to be chronologically listed regardless if it was held in the same business)
Tip 2: For each Job Title listed, a Claimant should be specific regarding the month, date and year when the job began and when the job ended.
Tip 3: For each Job Title, the Claimant should provide specific and detailed information as to what job duties were performed, what type of machines were used (e.g., injection mold, computer, ink press), examples of what was lifted/carried, the heaviest weight lifted, how much standing/walking was required, etc. In summary, the form should be filled out as if the form was a resume/application to a prospective employer. The goal is to provide sufficient information to SSA so SSA can properly assess the Claimant’s past work.
Tip 4: Each question for each Job Title should be answered with complete, accurate and truthful information. Providing inaccurate information or failure to answer a question will likely adversely impact the claim for benefits.
Tip 5: A Claimant should not guess, minimize or exaggerate answers. If a Claimant cannot recall the particulars of how a job was performed, the Claimant should contact the Claimant’s former employer and obtain a job description including but not limited to the exertional demands of the job (e.g., lifting frequently and occasionally) and posture requirements (e.g., sitting / standing / bending / squatting).
Tip 6: If a Claimant has had multiple Job Titles within the last 15 years and cannot recall each Job Title, the Claimant should contact SSA and request that SSA provide a Detailed Earnings Query (DEQY). A DEQY will identify each employer the Claimant has worked for within the last 15 years. The DEQY can be used as a tool to jog the memory as to job titles performed at a particular employer.