SAMHSA SOAR

SSA-3369: Work History Report

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.

About the Work History Report

DDS uses the Work History Report (SSA-3369) when additional information is needed to determine if the applicant is able to perform past relevant work or other work. This detailed report supplements information provided in the Adult Disability Report (SSA-3368) about the applicant’s past five jobs, and helps DDS see what types of work skills the applicant may possess.

When is it required?

DDS requires the completion of the SSA-3369 when they reach Step 4 of the Sequential Evaluation and there is not enough information provided in the Adult Disability Report (SSA-3368) to determine whether the person’s impairments are keeping them from being able to perform past relevant work or other work.
  • The DDS Examiner will contact the SOAR representative when this form is required as part of the application.

Completing the SSA-3369

The SSA-3369 provides space to list all the jobs the claimant had in the 15 years before becoming unable to work because of his or her illnesses, injuries, or conditions. It also provides space for the dates worked (month and year).
 
Pages 2-7 contain identical subsections, which ask for information about:
  • the rate of pay and hours of work per day and per week
  • the use of machines, tools or other equipment
  • amount of bending, sitting, walking, or related activity
  • whether the claimant had to do any writing
  • basic job duties
  • other descriptive data providing a complete picture of the nature and duties of the job performed
SOAR Tip: If the applicant does not remember all the details of his or her past work, enter “I don’t know” or “unknown” and explain any difficulties with memory in the Remarks section. It is important to not leave questions unanswered.
 
Provide additional details or jobs held in the Remarks section. Be sure to indicate that you helped complete the form and add that this is a SOAR application.

Submitting the SSA-3369

Fax the form back to the DDS examiner using the provided barcoded cover sheet
 
Check out this SOAR webinar and accompanying resources: Understanding and Using Vocational Information for Quality SOAR Applications

Details

Type:
SSA Forms
Date:
April, 2015

Other Details