SSA-3369-BK 2005 free printable template

1 2 3 Lowell Finley, SON 104414 LAW OFFICES OF LOWELL FINLEY 1604 SOLANO AVENUE BERKELEY, CALIFORNIA 94707-2109 TEL: 510-290-8823 FAX: 510-526-5424 4 Attorneys for Plaintiffs and Petitioners 5 SUPERIOR

How to fill out SSA-3369-BK

How to fill out SSA-3369-BK

1. Begin by providing your personal information, including your name, Social Security number, and date of birth.
2. Fill out the section regarding your medical conditions. List all impairments and their severity.
3. Provide detailed information about your daily activities and how your impairments affect them.
4. Include information about your treatment history, including dates and types of healthcare providers you have seen.
5. Describe your work history over the past 15 years, including job titles, duties, and dates of employment.
6. Review all sections for accuracy and completeness before submitting the form.

Who needs SSA-3369-BK?

1. The SSA-3369-BK is needed by individuals applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) who have a medical condition that impairs their ability to work.

Instructions and Help about SSA-3369-BK

This is the work history report provided to claimants who have applied for Social Security disability benefits this form does come directly from the Social Security office it is not sent to you from your attorney it is sent to you from the Social Security office in order for them to gather all the information they need in order to make a decision on whether you qualify for disability benefits and if you will be awarded obviously the more work you have the more work credits you have which will affect the award amount we often have clients that ask us if they have to fill this out or how much of it they have to fill out do they really have to go back 15 years and the answer to those questions or yes to all of them you do need to fill this out your attorney cannot do this for you because you know your history the best however at least here at the Kali law firm where he'll be happy to help you walk you through the form and if you just physically cannot write or tie then of course we would help you with it if you don't have someone at home that can do it for you the first page section one just asks for your name social security number and daytime telephone number where you can be reached any time you need to put all this information in because this will associate it to your disability application section two is information about your work so the first portion it does asks to list all the jobs that you've had in the last 15 years you need to list everything that you've had what your job was what type of business it and the days that you work as close to as accurate as possible obviously 15 years ago it's hard to remember exact dates and that's fine don't worry about it just keep it as you know accurate as possible once you've listed just all your jobs and the next several pages each pages for each job and is asking for very specific information it's asking for your rate of pay whether it's hourly or salary how much you worked how many days per week that you worked and then a description of the job itself what did you do all day they're going to get a sense of just your type what type of work that you're qualified to do you were healthy and then ultimately based on this and then Medical has history and other things they'll be able to determine if you're able to continue doing this sort of job this is why you've hired an attorney we do the argument for you defense for you, but we do need you to fill out this information after you've given a description of the job you will just answer the remaining questions give them an idea of how often or how what the frequency of how much you did something like walking or standing were you on your feel a day did you have to crawl or crouched let's say you're someone that has a shoulder injury, and you can no longer lift things, but that's what all your work history is that's good supporting your case you want to make sure you give them accurate information of how much you lifted during your jobs again this section...

People Also Ask about

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

6 tips for filling out the Work History Report Don't exaggerate or downplay your duties. Always answer questions truthfully, but avoid exaggerating or understating your job duties. Be concise. Give specific answers. Keep your answers consistent. Use the Function Report as your guide. Answer all questions.

What is the SSA 3369 BK 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.

Can you submit SSA forms online?

Our application process includes steps to verify the identity of the signer, and we continue to protect the information and records we receive. When filing online, applicants can print a copy of the signed SSA-827 for their records.

How to fill out Social Security disability Questionnaire?

9 tips for filling out the function report Keep your answers consistent. Start with question 20. Answer questions directly. Talk about your average or worst days. Be honest and don't exaggerate. Send additional information as quickly as possible. Talk about all conditions that keep you from working.

What is form SSA 3369 BK?

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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What is SSA-3369-BK?

SSA-3369-BK is a form used by the Social Security Administration (SSA) to collect information about an individual's work history and the impact of their impairments on their ability to work.

Who is required to file SSA-3369-BK?

Individuals who are applying for Social Security disability benefits or Supplemental Security Income (SSI) and need to provide information about their past work activity and medical conditions are required to file SSA-3369-BK.

How to fill out SSA-3369-BK?

To fill out SSA-3369-BK, individuals should provide detailed information regarding their work history, including job titles, duties, and relevant medical information. It's important to be thorough and accurate to reflect the impact of their impairments on work capabilities.

What is the purpose of SSA-3369-BK?

The purpose of SSA-3369-BK is to assist the SSA in evaluating a claimant's work history and extent of impairments to determine eligibility for disability benefits.

What information must be reported on SSA-3369-BK?

SSA-3369-BK requires information about past jobs, including job titles, job duties, dates of employment, and details about the physical and mental demands of the work, along with information about medical conditions affecting work ability.