List every job from the last 15 years with detailed duties — SSA compares your limitations to job demands

Describe the PHYSICAL requirements: lifting, standing, walking, bending

Include supervisory duties, tools used, and how much time was spent on each activity

Social Security Disabilityhard

Work History Report

SSA-3369-BK · SSA

10-page report requiring detailed descriptions of all jobs held in the past 15 years including physical demands, tools used, supervision, and lifting requirements.

Form Details

Total fields: 80
Auto-fillable: 15 (19%)
Time without BeneFill: 60 minutes
Time with BeneFill: 20 minutes
Time saved: 40 minutes
Filled by: patient
Frequency: one time

Fill this form with BeneFill

Auto-fill 19% of fields from your profile. Save 40 minutes. Download a real PDF.

15 of 80 fields19% auto-filled

Start Filling Upload Your Copy Instead Download blank official form

Where to Submit This Form

🌐

SSA.gov

https://www.ssa.gov/disability/

Submit as part of your online disability application.

📬

Return to your local SSA office or the address provided

https://secure.ssa.gov/ICON/main.jsp

🏢

In person at local SSA office

https://secure.ssa.gov/ICON/main.jsp

Filing Deadline

Usually 30 days from when SSA sends it to you. Call SSA at 1-800-772-1213 for an extension.

Processing Time

Part of your disability claim — processed alongside your application.

What Happens Next

SSA uses this to determine if you can return to past work or do other types of work. A vocational expert may review your history.

Tips for This Form

✓ List every job from the last 15 years with detailed duties — SSA compares your limitations to job demands
✓ Describe the PHYSICAL requirements: lifting, standing, walking, bending
✓ Include supervisory duties, tools used, and how much time was spent on each activity
✓ If you had to reduce hours or change duties due to your condition, explain that

You Might Also Need

Adult Disability Report

SSA-3368-BK · SSA

The most complex patient-facing disability form. 15 pages requiring complete medical history, all diagnoses, medications, treating providers, hospitalizations, and work history.

Function Report

SSA-3373-BK · SSA

10-page functional assessment covering ADL capacity, daily routines, social functioning, cognitive abilities, and physical limitations.

SSDI Application

SSA-16-BK · SSA

Application for Social Security Disability Insurance Benefits. Requires detailed work history, earnings record, and medical condition documentation.

SSI Application

SSA-8000-BK · SSA

Application for Supplemental Security Income for aged, blind, and disabled individuals with limited income and resources. Must be completed via SSA interview.

Authorization to Disclose Information

SSA-827 · SSA

Authorization allowing SSA to collect medical and other information from providers, hospitals, and other sources for disability determination.

Continuing Disability Review Report

SSA-454-BK · SSA

Required review for current SSDI/SSI recipients. 10-page form documenting current medical conditions, treatment changes, and functional status over the past 12 months.

Not sure which forms you need?

Tell our assistant about your situation and we'll find the right forms for you.

Chat with Form Assistant

Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the SSA or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.