Form SSA - 3369-BK
The form SSA-3369-BK is to be completed to document your work history. The form is used whenever Section 3, "Information About Your Work" on the SSA-3368-BK shows more than one job in the last 15 years, even if all the jobs have been listed on the SSA-3368. If you have not had a career change or job type change in the past fifteen years, you probably do not need this form.
All of the disability forms are entered electronically into Social Security's computer system. You will usually receive a copy of the actual application form (not this SSA-3368 or other forms.) Social Security does not keep paper copies of forms once they are entered into the computer. The electronic file becomes the official file for Social Security purposes. If you want a copy of any forms that are online, you need to ask for a copy.
You can see the form at: www.socialsecurity.gov/forms/ssa-3369.pdf
How To Complete The Form
Section 1 -- This section simply asks your name, Social Security number, and telephone number. In order not to miss a call from Social Secrity, consider providing your moblle number if you have one.
Section 2 Information About Your Work -- This is very similar to Section 6 of the Disability Report (SSA-3368-BK).
- Job Title -- This is the type of work, not the specific job. If, for example, you were a cook and have worked at ten different restaurants in the past 15 years, you would only complete one line. While you may enter each separate job on a different line, you do not need to. However, if there were substantial differences in responsibilities or in the requirements of the job, it is preferable to use different lines.
TIP: Before you complete this section, read the next section about "Job Specifics." It may help you determine what to say here and in how many lines.
- Job Specifics -- The remainder of this form asks for more specific information about the various job types you have held. This can help you decide how many lines you need to complete of the Job Title sections on Page 1. If the answers in the later sections would be substantially different even though the job titles were the same or similar, then it is advisable to complete multiple lines on Page 1. If you need additional space, use Section 3, Remarks. Include reference to the question you are answering, such as Job Title No. 6.
- So, "cook" would only be one job title even if you cooked for a different restaurant every year for the past 15 years.
- If, however, you taught a cooking class, that would be a separate job title.
- Also, if you were a maitre d' in a restaurant that would be a different job title although the Type of Business would still be a restaurant.
- Social Security asks mostly about the physical aspects of the job, whether you have to walk, run, crawl, write, stoop, etc. in your job as well as how much you can lift. It's up to you to add the mental aspects of the job, especially if you are having trouble doing that portion of the job. Either include it in Section 3 under "Remarks" or, if it fits, put it in the "Describe this job" blanks under the appropriate job title. (As noted above, if you used Section 3, include a reference to the section to which the additional information applies.)
- For Example: You were a telephone customer service representative. In the "Describe this job" section you wouldn't just write, "Sat at a desk and answered phone calls." You should give a more in-depth description, such as: "Handled 12 to 20 phone calls per hour from customers who were usually irate. It was my job to try to resolve their problem plus defuse their anger and calm them down enough to find out exactly what their problem was."
- This form has Section 3 for additional remarks.
- Carefully number each answer you put in Section 3 so you will remember which question you answered when you review the form with the Social Security Representative, and so reviewers will also understand which question you are answering.
- Use additional paper if necessary. Mention in Section 3 that additional sheet(s) are attached, and put your name and Social Security Number on each page as well as the Social Security form number.
NOTE: If you cannot fit all the information you want to convey on the form, attach extra pages. On the top or bottom of each page, note your name, Social Security number and the form number to which it is attached. Also include notation about the specific section to which the information applies.
It is advisable to photocopy everything before turning it in to Social Security, and filing the copy in an easy-to-access location.
When you submit papers to Social Security or DDS, ask for a written receipt that lists all the documents you submit and that is date-stamped.
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