SSA 3369 BK PDF Template

[toc] There’s a great deal of paperwork you’ll need to fill out if you apply for Social Security Disability benefits. These benefits are regulated by the Social Security Administration. The SSA-3369 form is the official form put out by the SSA. It gathers details about your work history, including your job titles, previous employment positions, and the amount of time that you worked in each of the positions. You can find this SSA 3369 BK fillable document with PDFSimpli here.

When a person becomes disabled, they can seek disability benefits from the Social Security Administration. These benefits are given to people who cannot work so that they can maintain basic parts of their lifestyle like rent payments, grocery shopping, and utility payments. The application process involves gathering, completing, and submitting a great deal of paperwork. One of the many documents involved in the Work History Report.

The Work History Report covers the fifteen years prior to the time that your disability stopped you from working. It will ask you to give your previous employment positions, job or occupation titles, and the amount of time and dates that you worked in each of these positions.

You’ll also need to give specific information about each of the jobs on the list. The form asks you to explain what kind of labor you performed and what physical requirements each job entailed. This includes the amount of weight you had to lift, along with the frequency with which you had to walk, stoop, pull, push, or stand.

This information is used by the SSA to understand how the medical condition affects the claimant’s ability to do the work required by the jobs they’re qualified for. The report illustrates what work you’ve previously done, what job skills you’ve acquired, and what experience you’ve gained over the years.

There are a few main points to this form. The most straightforward purpose is to show the SSA what kind of work you’re qualified for. The other point of the form is to illustrate that you aren’t qualified to do any type of work that wouldn’t aggravate your medical condition. You need to prove that your medical condition limits you from all fields of work for which you might be qualified.

This form is an essential part of any disability application. If you’re filing for disability benefits, you need to complete this form. Alternatively, if you have a representative taking care of your disability case, the representative would need to complete the form with the information they’ve gathered from the claimant.

This is one of the main forms used by the SSA to determine your eligibility for disability benefits. As such, it will be part of the bulk of paperwork that the SSA initially requests to process your case. You should file the documentation at the same time that you file your other preliminary case paperwork.

If you don’t complete this form, the SSA will not be able to process your disability claim. This is the main form used to give the SSA an idea of your previous work history, your current work experience, and your skills in the workplace. All of this information is vital to making a decision regarding your disability benefits.

Without this form, you cannot definitively prove to the SSA that you’re incapable of working. They won’t approve a claim that’s missing such vital information.

When you’ fill out the form, it’s important to answer all of the questions. No sections should be left blank. If a question isn’t relevant to your case, or you aren’t sure what the answer is, you should write “does not apply” or “I don’t know.”

Blank questions cause the SSA to have to gather more information before they can make a decision about your disability benefit eligibility.

In Section 1, give basic information about yourself. Provide your name, SSN, and your daytime telephone number. In Section 2, list every job you’ve had for the past 15 years. You’ll need the job title, the type of business you worked in, and the dates that the work occurred.

On the next page, under “Job Title No. 1,” you’ll need to answer questions about the first job you listed. Indicate your rate of pay, the hours you worked per day, and the days you worked per week. You’ll also need to describe the job. If you end up needing more room for the description, you can continue in the “Remarks” section at the end of the form.

Explain the number of hours you walked, stood, sat, climbed, or stooped. Answer the Yes/No questions regarding whether you used machines, technical knowledge, or did any writing. If you did any lifting or carrying, explain more about what types of objects were lifted and how often this task was performed. You’ll also need to put a checkmark next to the heaviest weight you lifted, along with weight you frequently lifted.

If you supervised people in the job, you’ll need to answer the relevant questions.

You’ll need to answer the same questions for the rest of the jobs you listed for the past 15 years. The last page is the Remarks section, which you’ll use if you run out of space for explanations in any other part of the form.

In the end, you’ll provide the date, your address, and optionally your email address. If the person completing the form is not a disabled person, they’ll need to print their name.[pdf-embedder url=”https://cdn-prod-pdfsimpli-wpcontent.azureedge.net/pdfseoforms/pdf-20180219t134432z-001/pdf/form-ssa-3369-bk.pdf?sv=2018-03-28&si=readpolicy&sr=c&sig=MXHnWmn0sXNXztiU%2Bugk2d7DV7KBCOuXF3oBMx0EeEw%3D”]