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Ssa 3369 bk-2025

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The document is a Work History Report (Form SSA-3369-BK) used by the Social Security Administration to collect information about an individual's work history for disability benefit claims. It instructs the claimant or their representative to provide detailed descriptions of jobs held in the 15 years prior to becoming unable to work due to illness or injury. The form emphasizes the importance of accurate and complete information, including job duties, physical demands, and supervisory roles, to assist in determining eligibility for benefits.

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Click ‘Get Form’ to open the SSA 3369 BK in the editor.
Begin by filling out Section 1, which requires information about the disabled person. Ensure you provide their name, Social Security number, and daytime phone number.
Move to Section 2, where you will list all jobs held in the last 15 years. For each job, include the job title, type of business, and dates worked. Use our platform's text fields to enter this information clearly.
For each job listed, provide detailed descriptions in the designated areas. Include your rate of pay and daily responsibilities. If more space is needed, utilize the 'REMARKS' section on Page 8.
Complete Section 3 by adding any additional remarks or clarifications necessary for your application. Don't forget to include your name and address if someone else is completing the form.

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How do you respond to a function report?

Be honest but don't exaggerate. Be specific about your limitations. If you do not clearly describe your limitations or give vague answers on your Adult Function Report, Social Security will take that to mean your disability really isn't that bad and you should have no problem returning to work.

What are the 3 main types of Social Security benefits?

Social Security pays five types of benefits: Retirement. Disability. Spouse's/dependent children. Survivors. Medicare.

How do I fill out a work history report for disability?

0:48 6:49 How to Fill Out the Social Security Work History Report Form (SSA ... YouTube Start of suggested clip End of suggested clip So what you do is you list the job titles that you've had in the last. 15 years before the onsetMoreSo what you do is you list the job titles that you've had in the last. 15 years before the onset date of disability. And keep it simple don't use fancy terms like managers. And supervisors.

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What is a form SSA 3369 BK?

Form SSA-3369-BK is a work history report for adults who are seeking to receive disability benefits from the Social Security Administration. The information within the report is used to determine whether the applicant meets the SSA's qualifications to be considered disabled.

What is a function Report adult third party?

Third Party Adult Function Report is a form that Social Security sometimes send to your contact person. This form is usually sent out two or three months after you first apply. It is also sometimes used during Continuing Disability Reviews, for people who are already on disability.

Why did I receive a SSA 3380 BK?

If SSA reaches out to your contacts, they will receive Form SSA-3380-BK or the Third Party Function Form. This does not mean that there is a problem with your application, but it does mean your case was not clear-cut. The form asks your contacts very detailed questions about your ability to function in daily life.

Why did I get SSA 821 BK?

In fact, the SSA directs form 821-BK to an individual who is already receiving disability insurance benefits (which means they are considered disabled and cannot be working) to make sure that the beneficiary hasn't been doing any work activity since the alleged onset date.

What is a SSA 3369 form?

The Work History Report (SSA-3369) helps Disability Determination Services (DDS) to obtain detailed vocational information about the jobs the applicant held in the 15 years prior to becoming unable to work due to his or her illnesses, injuries, or conditions.

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