TN 3 (04-18)

DI 22515.025 Use of Form SSA-3368-BK (Disability Report – Adult)

Review the following Sections on Form SSA-3368-BK (Disability Report – Adult) to determine whether this form provides sufficient vocational evidence. The information provided on SSA-3368-BK, in Sections 4, 5, and 6 may be vocationally relevant. Information in Sections 4 and 6 may also provide information that affects developing onset or unsuccessful work attempt(s).

A. Section 4 – Work activity

You will find information about the work activity pertinent to onset on Form SSA-3368-BK, Section 4. Some of this information pertains to whether the work is substantial gainful activity (SGA).

For more information on SGA, see DI 24001.010.

For more information about making a determination of capacity for past work, see DI 25005.015.

B. Section 5 – Education and training

You will find education and training information on Form SSA-3368-BK, Section 5.

C. Section 6 – Job history

You will find job history information on Form SSA-3368-BK, Section 6.

You will find a list of jobs with basic information in Section 6.A.

If the claimant had only one job in the last 15 years, then you may find a complete vocational description of that job in Sections 6.B through 6.I, see DI 11005.023C.6. You may need to develop additional job history, particularly when the information is incomplete or the form lists more than one job during the relevant 15-year period. Be alert for job information located elsewhere in the file or in a prior file. For more information about the relevant work period, see DI 25001.001A.64.

D. Considering evidence for the special medical-vocational profiles

Pursue targeted vocational evidence to gather details about the special medical-vocational profiles early in the development process when applicable. For information on special medical-vocational profiles, see DI 25010.001.

Be alert for information that shows:

  • 35 years or more in arduous unskilled work with a marginal or less education (grade 6 or less) – arduous unskilled work profile;

  • no past relevant work experience, age 55 or older with a limited or less education (grade 11 or less) – no work experience profile; or

  • 30 years or more in one job or field of work, age 60 or older with a limited or less education – lifetime commitment profile.

If the claimant potentially meets the arduous work or lifetime commitment profile, you will have to document the claimant’s work beyond the 15-year relevant period.

E. Job information we need to know about past work

1. Information needed about each job

We need the following information about each job:

  • job title,

  • dates worked,

  • hours worked per week,

  • rate of pay,

  • tools, machinery, and equipment used,

  • knowledge, skills, and abilities required,

  • nature and extent of supervision,

  • description of tasks and responsibilities, and

  • strength, endurance, postural, and physical demands.

2. Information needed when the claimant has a mental or physical impairment with psychiatric manifestations

We may need the following additional job information when the claimant has a mental impairment or psychiatric manifestations:

  • production requirements,

  • quality requirements,

  • complexity of tasks,

  • use of independent judgment, and

  • need to work with, or in close proximity, to other people.

3. Clarify inconsistent information

Determine whether the information on the SSA-3368-BK is reliable and material to the determination. Clarify any inconsistent information material to the determination. Do not pursue additional development to make clarifications on inconsistencies that are not material to the disability determination. For example, past relevant work (PRW) information is not material if the expedited vocational procedures apply, see DI 25005.005.

If the job duties described in the SSA-3368-BK seem inconsistent with the claimant’s stated exertional and nonexertional demands, and information about that particular job is material to the determination, you must resolve the issue with the claimant if information about a particular job is material to the determination.

Example: The claimant stated in Section 6.B. he spent all day collecting trash from individual offices and then dumping that trash into a large dumpster at the end of the day. However, in Section 6.E., he also stated he performed no lifting as part of his job duties. You would need to clarify the discrepancy between the job description and specific task if his ability to do that job as he described it was material to the determination. If he was required to collect trash by lifting it into the dumpster at the end of the day, lifting was part of his job duties.

4. Inconsistencies in time spent doing work requirements and hours worked

Only clarify time spent doing work requirements and hours worked if it is not possible to make reasonable assumptions about the claimant’s intended meaning. For example, the combined hours spent in various tasks do not need to match the total hours worked. Some tasks performed may overlap. For example, a claimant may stand while stooping and reaching. In some instances, it may be difficult for the claimant to parse out the difference between hours standing and hours walking. For example, if the claimant stated he stood six hours and walked six hours in an eight-hour day that is likely an indication that he spent six hours a day standing or walking intermittently.

Even for instances in which the claimant provides extremely inconsistent times spent doing various work requirements, it may be possible to rule out the claimant’s ability to do that job as performed without further clarifications. For example, the lifting and carrying requirements of the job may be beyond the claimant’s RFC level, making further clarification of hours spent standing and walking immaterial to the determination.

F. References

DI 11005.023 Completing the Disability Report Adult Form SSA-3368

DI 24001.010 Effect of SGA on Disability Status

DI 25005.005 Expedited Vocational Assessment at Steps 4 and 5 of Sequential Evaluation

DI 25005.015 Determination of Capacity for Past Work – Relevance Issues

DI 25010.001 Special Medical-Vocational Profiles


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DI 22515.025 - Use of Form SSA-3368-BK (Disability Report - Adult) - 04/25/2018
Batch run: 04/25/2018
Rev:04/25/2018