SSA-3369-BK 2011 free printable template

Job Title Type of Business Dates Worked From To Form SSA-3369-BK 04-2011 ef 04-2011 Destroy Prior Editions PAGE 1 Give us more information about Job No. 1 listed on Page 1. WORK HISTORY REPORT- Form SSA-3369-BK READ ALL OF THIS INFORMATION BEFORE YOU BEGIN COMPLETING THIS FORM IF YOU NEED HELP If you need help with this form complete as much of it as you can* Then call the phone number provided on the letter sent with the form or the phone number of the person who asked you to complete the...

How to fill out ssa 3369 bk 04

How to fill out ssa 3369 bk 04?

1. Gather all necessary personal information, including your full name, Social Security number, date of birth, and contact information.
2. Provide details about your medical conditions and impairments. Be specific and thorough, including any symptoms you experience, treatments you have received, and the impact these conditions have on your daily life and ability to work.
3. Include information about your educational and work history, including any previous jobs you have held, your level of education, and any specialized training or skills you possess.
4. Describe any medical treatments or therapies you are currently receiving or have received in the past. This includes medications, surgeries, physical therapy, counseling, or any other medical interventions.
5. Provide a detailed description of your work limitations and how your medical conditions affect your ability to perform specific tasks necessary for employment.
6. If applicable, include information about any assistive devices or accommodations you use or require due to your disabilities.
7. Ensure that all information provided is accurate, complete, and up-to-date.
8. Sign and date the form, and submit it to the Social Security Administration.

Who needs ssa 3369 bk 04?

1. Individuals who are applying for Social Security Disability Insurance (SSDI) benefits.
2. Individuals who are applying for Supplemental Security Income (SSI) benefits based on disability.
3. Individuals who are requesting a medical review or reconsideration of a previously denied disability claim.

Instructions and Help about ssa 3369 bk 04

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 ssa 3369 bk 04

What is the pain questionnaire for Social Security disability?

The pain questionnaire is asking how pain limits the individual and how often they are experiencing the pain. This form will also ask about any medications they are taking and any side effects the medication is causing. Side effects from medications can also help you show how else your client is limited.

How to answer questions on a function report for disability?

How to Fill Out an Adult Function Report for Disability (7 Tips) Answer Every Question and Be Honest! Answer Only the Questions Being Asked. Give as Much Detail as You Can. Be Consistent (Some Questions Overlap) Be Specific on Question 5 of the Function Report. Don't Limit Your Answers to the Space on the Form.

Why did I receive a SSA 3373 BK?

DDS requires the completion of the SSA-3373 when they do not have enough information in the medical records to determine whether the person's impairments are keeping them from being able to function in a work environment.

How do you answer a disability questionnaire?

How to Answer Disability Questionnaires Write clearly and legibly. Avoid erasures as much as possible. Do not leave any section of the form blank (unless otherwise specified). Give consistent answers. Answer the questions truthfully. Follow the instructions on the form.

When is pain considered a disability?

If you have a chronic pain condition that renders you incapable of working, you may qualify for Social Security disability (SSD) benefits. However, qualifying can be a challenge because the Social Security Administration has a strict definition of what it means to be disabled.

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.

For pdfFiller’s FAQs

What is ssa 3369 bk 04?

SSA 3369 BK 04 is a form used for the Disability Report - Adult.

Who is required to file ssa 3369 bk 04?

Any adult who is applying for disability benefits.

How to fill out ssa 3369 bk 04?

To fill out SSA 3369 BK 04, you need to provide information about your medical conditions, work history, and daily activities. It is recommended to consult with a medical professional or an attorney for assistance.

What is the purpose of ssa 3369 bk 04?

The purpose of SSA 3369 BK 04 is to gather detailed information about an individual's medical conditions and daily activities to assess their eligibility for disability benefits.

What information must be reported on ssa 3369 bk 04?

SSA 3369 BK 04 requires information about the applicant's medical conditions, treatments, medications, work history, education, and daily activities.

When is the deadline to file ssa 3369 bk 04 in 2023?

The deadline to file SSA 3369 BK 04 in 2023 may vary depending on individual circumstances. It is best to check with the Social Security Administration (SSA) or consult with an attorney for specific deadlines.

What is the penalty for the late filing of ssa 3369 bk 04?

The Social Security Administration (SSA) may not impose a specific penalty for late filing of SSA 3369 BK 04. However, it is important to file the form as soon as possible to avoid delays in the disability benefit application process.

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