How to Fill Out Form SSA-3369-BK (w/Examples) + FAQs

The Social Security Administration’s Work History Report, known as Form SSA-3369-BK, asks you to describe every job you held during the relevant lookback period so the agency can decide if you can still do that work despite your medical condition. You must list each job title, dates worked, hours, pay, physical demands, and mental demands in plain, accurate language because the Disability Determination Services (DDS) examiner and the vocational expert use your answers to apply the five-step sequential evaluation under 20 CFR §404.1520. If you describe your past work as easier than it really was, the examiner can deny your claim at Step 4 by ruling that you can still perform your past relevant work.

In June 2024, the SSA shortened the past relevant work (PRW) window from 15 years to 5 years under Social Security Ruling 24-2p, a change that affects how you complete Section 2 of the form. According to the SSA’s 2024 Annual Statistical Report, only about 38% of initial disability claims are approved, and a poorly drafted Work History Report is one of the most common reasons for a Step 4 or Step 5 denial. The form looks simple, but each blank line carries legal weight under the Dictionary of Occupational Titles (DOT) and the GRID rules in Appendix 2 to Subpart P.

In this guide, you will learn:

📋 How to complete every section of the SSA-3369-BK line by line with named examples
⚖️ How the new 5-year PRW lookback rule under SSR 24-2p changes your answers
🧠 How to describe the mental and physical demands of past jobs without sabotaging your claim
🚫 The seven most common mistakes that trigger Step 4 denials and how to avoid each
✅ Sample wording, scenario tables, and FAQs you can adapt to your own work history

What Form SSA-3369-BK Is and Why It Matters

The Work History Report is the SSA’s primary tool for gathering vocational evidence at the initial and reconsideration levels of a disability claim. The form does not ask about your medical condition. Instead, it asks how you performed your past jobs so the agency can decide whether your remaining functional capacity, called your residual functional capacity (RFC), still allows you to do that work or any other work in the national economy.

DDS sends the form after you file your initial application, after you appeal a denial through reconsideration, and sometimes during a continuing disability review (CDR). You must return it within the deadline printed on the cover letter, usually 10 days, although you may request an extension by calling your DDS examiner.

The Legal Backbone Behind the Form

The form draws its authority from 20 CFR §404.1560 and §404.1565, which together define past relevant work as work you did within the last 5 years that lasted long enough for you to learn it and that counted as substantial gainful activity (SGA). The plain-English meaning is that not every job you list will count as PRW, but the examiner must still see each job to make that decision.

The consequence of misclassifying a job is severe. If you list a short, light job and forget to mark that it lasted only two weeks, the examiner may treat it as PRW and deny you at Step 4. A common misconception is that the form is just paperwork, but it is sworn evidence under 18 U.S.C. §1001, which makes false statements a federal crime.

Why the Form Decides Your Case at Step 4

At Step 4 of the sequential evaluation, SSA compares your RFC to the demands of your past relevant work as you actually performed it and as it is generally performed in the national economy under SSR 82-61. If your description shows that the job was light or sedentary, and your RFC allows light or sedentary work, you lose at Step 4 even if you cannot return to the actual employer.

The example of Pinto v. Massanari in the Ninth Circuit shows that the administrative law judge must rely on the claimant’s own description plus the DOT. If your description is vague, the judge defaults to the DOT, which often describes the job as lighter than reality.

The 5-Year Past Relevant Work Rule Under SSR 24-2p

For applications and continuing claims decided on or after June 22, 2024, the SSA only counts work performed in the 5-year window ending on the date of adjudication as past relevant work under SSR 24-2p. The old rule, found in the now-superseded SSR 82-62, used a 15-year window.

The plain-English meaning is that jobs you held more than 5 years before your decision date are no longer counted against you at Step 4. The consequence is huge for older workers, because the agency must now find more recent skills you could transfer to other work under the GRID rules.

How the New Rule Changes Section 2

You still must list every job from the past 5 years. The examiner uses the date you allege your disability began, called the alleged onset date (AOD), and works backward 5 years. A common misconception is that you should leave off older jobs, but you should still mention them in the remarks section if they explain skill levels or work patterns, because SSR 24-2p does not bar SSA from looking at older context for transferable skills analysis.

The Transition Period Trap

If you filed before June 22, 2024, but your claim is still pending, SSA applies the new 5-year rule to the decision, not the filing date, under the agency’s transition guidance. The consequence is that older claimants who filed under the 15-year rule now benefit from the shorter window. A real example is Maria, a 58-year-old former teacher who filed in March 2024 and was decided in August 2024, and whose teaching job from 2017 dropped out of PRW under the new rule.

Section-by-Section Walkthrough of Form SSA-3369-BK

The form has seven main parts. Each part carries different legal risk, so treat every blank as a sworn statement.

Section 1 — Information About You

This section asks for your name, Social Security number, and contact details. The risk is low, but make sure the name matches your SSA earnings record exactly, because a mismatch can delay processing.

If you go by a nickname at work, write your legal name here and add the nickname in Section 7 (Remarks). A common misconception is that this section is routine, but a wrong SSN can route your file to the wrong examiner under POMS DI 11005.045.

Section 2 — List of Jobs Held in the Past 5 Years

You must list every job in chronological order, with the job title, type of business, dates worked, hours per day, days per week, and rate of pay. Each row is a chance to anchor the truth of how you worked.

The plain-English meaning is that you should write the job title your supervisor used, not a fancy title from your resume. The consequence of using a fancy title is that the DOT may classify your work at a higher skill level (SVP 6, 7, or 8) than it really was, which makes it easier for SSA to find transferable skills under SSR 82-41. For example, Devon worked as a “guest experience associate” at a hotel, but the actual duties were front desk clerk, so he wrote “front desk clerk” on the form.

Section 3 — Information About Each Job

This is the heart of the form. For each job listed in Section 2, you must complete a separate job description block covering duties, machines used, lifting, carrying, sitting, standing, walking, stooping, kneeling, crouching, crawling, reaching, writing, and supervisory duties.

Job Title and Description of Duties

Use one or two sentences for each main duty. The plain-English meaning is to describe what you actually did, not what the job description said. For example, instead of “managed inventory,” write “lifted 50-pound boxes from the truck, scanned them with a handheld scanner, and stacked them on shelves up to 6 feet high.”

The consequence of being vague is that the DOT default takes over. A common misconception is that more words help, but precise verbs and weights help more.

Machines, Tools, and Equipment

List every piece of equipment, even small items like a stapler or a forklift. The plain-English meaning is that the examiner uses this list to decide if your job had specific vocational preparation (SVP) under Appendix C of the DOT.

The consequence of leaving items off is a lower SVP rating, which can hurt you if you are over 50 and seeking the protection of the GRID rules. A real example is Linda, a 56-year-old former medical assistant who listed her use of EKG machines, phlebotomy supplies, and electronic health records, which moved her job from SVP 4 to SVP 6 and helped her qualify under Grid Rule 202.06.

Lifting and Carrying

Write the heaviest weight you lifted and the most frequent weight you lifted. The form gives checkboxes for less than 10 pounds, 10 pounds, 20 pounds, 50 pounds, and 100 pounds or more.

The plain-English meaning is that SSA uses these numbers to assign your past job to one of five exertional categories under 20 CFR §404.1567: sedentary, light, medium, heavy, or very heavy. The consequence of underreporting weight is that the job may be classified as light when it was really medium, which makes it easier for SSA to find you can still do it.

Postural Activities

Estimate the hours per day you spent sitting, standing, walking, stooping, kneeling, crouching, crawling, and reaching. Be honest, because the numbers must add up to your total work hours.

A common misconception is that “standing” includes walking, but the form separates them. For example, Roberto, a former warehouse worker, wrote 2 hours sitting, 4 hours standing, 2 hours walking, and noted that he stooped 30 times an hour to pick up boxes.

Supervisory Duties

If you supervised anyone, list how many people, what you supervised, and whether you had hire-and-fire authority. The plain-English meaning is that supervisory duties raise the SVP and can create transferable skills.

The consequence of overstating supervision is that SSA may find you have transferable management skills under SSR 82-41. A common misconception is that “lead worker” equals “supervisor,” but only true hire-and-fire authority counts as supervisory under the POMS DI 25015.017.

Section 4 — Education and Training

This section asks about your highest grade completed, special training, and certifications. The plain-English meaning is that your education level interacts with the GRID rules to decide if you are disabled at Step 5.

The consequence of misreporting education is that a high school graduate may be coded as a college graduate, which removes some Grid protections. A real example is Janet, a 55-year-old former cashier who had one semester of community college but listed herself as a high school graduate because she never earned a degree, which kept her in the more favorable education category.

Section 5 — Remarks

This is your free-text section. Use it to explain anything that does not fit the form’s boxes.

The plain-English meaning is that the remarks section is where you protect yourself from DOT defaults. The consequence of leaving it blank is that the examiner has no choice but to use the generic DOT description.

Section 6 — Signature

Sign and date the form. Your signature is sworn under 18 U.S.C. §1001, so every answer must be truthful to the best of your knowledge.

Section 7 — Witness (If Signed by Mark)

If you cannot sign your name, two witnesses must sign and provide their addresses under POMS GN 00201.015.

Three Real-World Scenarios with Outcomes

The following scenarios show how small differences in your answers change the outcome of a claim.

Scenario 1 — The Warehouse Worker

What the Claimant Wrote	What DDS Decided
“Loaded trucks” with no weights listed	Job coded as light, claim denied at Step 4
“Lifted 75-pound boxes onto trucks 40 times a day”	Job coded as heavy, claim approved at Step 4

Scenario 2 — The Medical Assistant

Form Answer	Vocational Impact
“Took vitals and filed charts”	Coded as SVP 3, semi-skilled, few transferable skills
“Drew blood, ran EKGs, used Epic EHR, coded ICD-10”	Coded as SVP 6, skilled, transferable to sedentary clerical

Scenario 3 — The Restaurant Manager

Description Used	Step 4 Result
“Managed staff and ordered food”	Coded as light, sedentary RFC denial
“Stood 7 hours a day, lifted 50-pound flour bags, hired and fired 12 staff”	Coded as medium, approved under Grid 202.06

Named Examples of Common Job Descriptions

The following named examples show how to write each block on the form. Use them as templates, not copy-paste answers.

Example 1 — Marcus, Former Construction Laborer

Marcus is 52 and hurt his back in 2023. He writes, “I worked as a construction laborer from 2019 to 2023. I lifted 80-pound bags of concrete 30 times a day, carried them 50 feet, and used a wheelbarrow, shovel, and jackhammer. I stood 6 hours, walked 2 hours, and stooped 100 times a day.”

This level of detail forces the examiner to code the job as heavy under 20 CFR §404.1567(d), which matches the DOT code 869.687-026.

Example 2 — Aisha, Former Office Manager

Aisha is 60 and has fibromyalgia. She writes, “I sat 7 hours a day at a computer, typed 6 hours, lifted 20-pound boxes of paper twice a week, supervised three clerks without hire-or-fire authority, and used QuickBooks, Excel, and a multi-line phone.”

By specifying that she had no hire-and-fire authority, Aisha keeps her job at SVP 6 instead of SVP 7, which limits transferable skills under SSR 82-41.

Example 3 — Henry, Former School Bus Driver

Henry is 58 and has uncontrolled diabetes. He writes, “I drove a 40-foot bus for 4 hours a day, walked the aisle 20 times a day, lifted a 30-pound wheelchair ramp manually, and supervised 45 children without hire-or-fire authority.”

This description preserves Henry’s commercial driver skills but shows the postural and lifting demands that exceed sedentary RFC.

Mistakes to Avoid When Filling Out the Form

These mistakes cause more Step 4 denials than any other factor in the disability process.

Writing generic duties like “office work” or “manual labor” instead of specific verbs and weights, which lets the DOT default to lighter exertion
Using inflated resume titles such as “operations specialist” when the real title was “stock clerk,” which raises SVP and creates fake transferable skills
Underreporting the heaviest weight lifted because you only lifted it occasionally, which moves the job into a lighter exertional category
Leaving the machines and tools list blank, which lowers the SVP rating and removes Grid protection for older workers
Listing jobs older than 5 years as past relevant work, which adds work that no longer counts under SSR 24-2p
Forgetting to use the remarks section to explain unusual conditions like reasonable accommodations under the ADA that made the job possible
Signing the form before checking that postural hours add up to total work hours, which makes the form internally inconsistent and reduces its weight

Do’s and Don’ts of the SSA-3369-BK

Do’s

Do write your actual job title as your supervisor used it, because matching reality protects you under SSR 82-61
Do list the heaviest weight you lifted, not the average, because the form’s exertion category depends on the maximum
Do describe accommodations in remarks, because POMS DI 25001.001 requires SSA to consider them
Do use specific numbers for postural activities, because vague answers let the DOT default override your description
Do return the form within the deadline or call DDS for an extension, because a missed deadline can trigger a failure to cooperate denial

Don’ts

Don’t copy your resume into the form, because resume language is written to impress, not to describe physical demands
Don’t guess at numbers, because the form is sworn under 18 U.S.C. §1001 and inconsistencies hurt your credibility
Don’t leave any block blank, because empty blocks let the examiner default to the DOT description
Don’t list every short-term job from more than 5 years ago, because they no longer count as PRW under SSR 24-2p
Don’t sign the form before reading every answer, because your signature locks in your testimony

Pros and Cons of Filling Out the Form Yourself

Pros

You know your jobs better than anyone, so your firsthand description carries credibility under SSR 16-3p
You save the cost of a representative at the initial level, where fees would still apply under 42 U.S.C. §406
You control the timing and can return the form within days
You learn the vocational framework, which helps you at later hearings before an administrative law judge
You avoid relying on a representative who may not know the recent SSR 24-2p changes

Cons

You may miss subtle vocational issues like transferable skills under SSR 82-41
You may unintentionally describe a job as lighter than it was, costing you a Step 4 win
You may forget to use the remarks section to anchor your description against the DOT default
You may misread the new 5-year PRW rule and overlist old jobs
You may not know the POMS DI 25015.017 standards for supervisory duties

State Nuances Within Federal Disability Law

Federal law controls every SSDI and SSI claim, so the SSA-3369-BK is identical in all 50 states. However, your state’s Disability Determination Services office handles the form, and processing times vary widely.

For example, the California DDS processed claims in an average of 220 days in 2024, while Texas DDS averaged 290 days. State workers’ compensation findings also interact with SSA’s offset rules under 42 U.S.C. §424a, so you should note any workers’ comp claims in the remarks section.

The plain-English meaning is that the form itself is federal, but the people reading it work for your state. The consequence is that local DDS culture can affect how strictly examiners read your descriptions, even though the legal standard is uniform.

Recap of Key Court Rulings

Courts have shaped how SSA reads the Work History Report for over four decades. In Pinto v. Massanari, 249 F.3d 840 (9th Cir. 2001), the Ninth Circuit held that an ALJ must rely on the claimant’s description of past work plus the DOT, not just the DOT alone.

In SSR 82-62, the agency required that any Step 4 denial include specific findings about the physical and mental demands of past work. In Henrie v. Department of Health and Human Services, 13 F.3d 359 (10th Cir. 1993), the Tenth Circuit held that a vague Step 4 finding violates due process. These rulings explain why your specific, detailed answers matter so much.

FAQs

Do I have to fill out Form SSA-3369-BK if I already filled out Form SSA-3368?

Yes. Form SSA-3368 collects medical information, while SSA-3369 collects vocational information, and both are required for a complete disability determination at every level.

Can I get help filling out the form?

Yes. A friend, family member, attorney, or SSA representative may help you complete the form, but you must sign it personally under penalty of perjury per 18 U.S.C. §1001.

Will SSA deny my claim if I miss the deadline?

Yes. SSA can deny for failure to cooperate, but you can call your DDS examiner before the deadline passes to request a written extension of usually 10 to 15 more days.

Does the new 5-year PRW rule apply to my pending claim?

Yes. Under SSR 24-2p, SSA applies the 5-year lookback to any decision made on or after June 22, 2024, regardless of when you filed the application.

Should I list jobs that lasted only a few weeks?

Yes. List every job from the past 5 years, but note short duration in remarks because 20 CFR §404.1565 excludes jobs you did not perform long enough to learn.

Can I submit a typed addendum instead of cramming answers into the boxes?

Yes. You may attach typed pages labeled with your name and SSN, and the DDS examiner must consider them as part of the official record.

Will lying on the form lead to criminal charges?

Yes. False statements on the form violate 18 U.S.C. §1001 and 42 U.S.C. §408, which carry fines and up to 5 years in prison for each false answer.

Do I list self-employment on the form?

Yes. Self-employment counts as work if it met substantial gainful activity levels, and you must describe duties, hours, and net earnings the same way you would a wage job.

Can my representative submit the form for me?

Yes. An appointed representative under Form SSA-1696 may submit the form, but your personal signature or mark is still required to make the statements binding.

Does SSA share the form with my former employer?

No. SSA keeps the form confidential under the Privacy Act of 1974, and does not contact your employer unless you authorize it through Form SSA-827.

Will the form be used at my hearing if I appeal?

Yes. The administrative law judge and the vocational expert at your hearing rely heavily on the SSA-3369-BK, so any inconsistency between the form and your hearing testimony can damage your credibility.

Can I update the form after I send it in?

Yes. You may send a corrected or amended Work History Report at any stage, and the DDS or hearing office must add it to the file as long as you sign and date the corrections.

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