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Disability and agingSupporting documentconditional

Social Security Work History Report

Official owner Social Security Administration

Describe jobs and their physical/mental requirements in the five years before inability to work, when disability staff request it.

What problem this helps solve

Describe jobs and their physical/mental requirements in the five years before inability to work, when disability staff request it.

Who completes it: Claimant or knowledgeable helper, with completed-report identity/date fields.

What this does not prove

Follow the requesting agency and notice; evidence report alone is not an application, appeal or approval.

Dated source check

Official destination opened — currentness caution

Fourteen-page 07-2026UF current report read; discontinues prior editions. Source Privacy Act paragraph includes unrelated hearing-withdrawal wording; anomaly retained rather than treating it as report purpose.

Last checked Sep 30, 2026. A working link does not establish the current edition, suitability, agency acceptance, or service availability.

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Direct document

Before downloading, confirm the agency, form number, and revision date match the summary below.

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Use the official pathway

NOLO's preparation notes summarize the dated sources in this record. Follow the agency's official instructions and current edition when they differ.

1. Check that this route fits

Stage and purpose
Requested work-history evidence
Who completes it
Claimant or knowledgeable helper, with completed-report identity/date fields.
Jurisdiction
United States
Application mode
Paper report; Requesting-office assistance

2. Prepare before starting

  • Use request letter's office, return route and deadline.
  • Prepare jobs in five years before inability to work.

Documents named by the source

  • Job names/dates, duties, tools, interaction, exertion/environment and impairment effect; use remembered information and mark unknowns as instructed.
Fees and fee waivers
UNKNOWN — no filing fee stated in checked form.
Account
No account stated for paper report; any electronic route UNKNOWN.
Appointment
UNKNOWN — requesting office can discuss help.
Signature
Section4 asks report completer and date; no separate signature located; requesting-office instructions control.
Third-party certification or assessment
Unknown — confirm any certification, referral, or assessment with the official owner.

3. Follow official submission instructions

Read official instructions
  • Send or bring to the state disability agency that requested report; not the generic Baltimore comments address

4. Get help or an accommodation

Languages: English form read; request SSA language help.

Accessibility: PDF conformance not evaluated. Use requesting-office help for inaccessible forms or inability to complete them.

5. Know the supported next step

  • Keep copy and submission evidence; return to requesting state agency.

Restrictions and unresolved details

  • Do not send report to time-burden comments address.
  • Do not invent answers when memory is incomplete.
  • Current PDF contains a purpose-text anomaly in its Privacy Act paragraph.

Follow the requesting agency and notice; evidence report alone is not an application, appeal or approval.

Continue with your journey

Return to the connected step to decide what to do next. Opening this record does not complete that step or submit an application. If the official route is unavailable, use the assistance options above or browse help in the journey.

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Form record

Adds to a private plan in this browser tab. Nothing is sent to the provider, and nothing is applied for.

Official title
Social Security Work History Report
Form number
SSA-3369-BK
Program
SSI and SSDI disability evidence
Jurisdiction
United States
Revision / edition
Jul 2026
Who completes it
Claimant or knowledgeable helper, with completed-report identity/date fields.
Signature
Section4 asks report completer and date; no separate signature located; requesting-office instructions control.
Submission methods
Send or bring to the state disability agency that requested report; not the generic Baltimore comments address
Supporting documents
  • • Job names/dates, duties, tools, interaction, exertion/environment and impairment effect; use remembered information and mark unknowns as instructed.
Languages
English form read; request SSA language help.
Accessibility
PDF conformance not evaluated. Use requesting-office help for inaccessible forms or inability to complete them.

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  • • Read the agency’s privacy and consent language before entering personal information.
  • • Save a confirmation or reference number if one is provided.
  • • If a page asks for payment unexpectedly, stop and confirm the fee with the agency.

Source note: Follow the requesting agency and notice; evidence report alone is not an application, appeal or approval.

NOLO does not process this form, receive your answers, decide eligibility, or represent the agency. A destination check does not confirm current funding, acceptance, or an outcome.

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