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. It's important to complete the report in full, including explaining the physical requirements each job had. SSA will use the information to determine whether they believe youc an continue to work in a similar job capacity.

What is a SSA 3369 BK?

This form will be used by the Social Security Administration in order to determine if someone is eligible for social security benefits. The Form SSA 3369-BK is known as the Work History Report, and it will need to be included will any application for benefits, such as disability or SSI benefits. This form will need to include all the information about your previous employment in order to determine your eligibility for benefits.
For each job, you will need to list what the job was, what the pay was, and what you had to do at this position. You will need to include how physical the job was, and how often you had to lift things, bend down or squat, and climb. This information is required for the Social Security Information to determine whether or not you have the ability to continue working at your current job or in a similar field.

Why is it important?

Form SSA-3369 is important because it helps the SSA determine how your medical condition will affect your ability to work.  The form shows the SSA they type of work you’ve done in the past and the skills you’ve gained in the past.  It also gives insight into what types of work you were previously able to perform.

How to complete an SSA 3369 BK (Step by Step)

When completing your SSA-3369-BK, you should ensure that you answer every question on the form.  Do not leave blank spaces.  Indicate when you do not know the answer to a question or if you do not know the answer.

To complete a SSA-3369 form, you will need to provide the following information:

  • Section 1 - Information About the Disabled Person
    • Name
    • Social security number
  • Section 2 - Information About Your Work
    • Job title 
    • Type of business
    • Dates worked
    • Rate of pay
    • House per day
    • Days per week
    • Description of job
    • Whether you: used machines, tools, or equipment; used technical knowledge or skills; did any writing, completing reports, or similar duties
    • Total hours per day spent doing the following: walk; stand; sit; climb; stoop; kneel; crouch; crawl; handle, grab, or grasp big objects; reach; write, type, or handle small objects
    • Description of any lifting and carrying activities, heaviest weight lifted, and weight frequently lifted
    • Whether you supervise other people, how many people you supervised, whether you hired and fired employees, whether you were a lead worker
  • Section 3 - Remarks
    • Any information you did not have space for in other parts of the form
  • Name of person who completed form if other than disabled person, date, address, email address

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