TN 12 (06-24)

DI 22515.030 Use of Work History Report Form SSA-3369-BK

A. Vocational development

IMPORTANT: For title II claims with an entitlement period in the past, ask the claimant to document each job held during the five years prior to the entitlement period end date.

For an overview of vocational evidence development, see DI 22515.001.

1. Telephone or direct contact development

When you need detailed vocational information (in addition to that shown on the SSA-3368-BK (Disability Report – Adult) for the claimant's described job), proceed as follows:

  1. 1. 

    If you obtain vocational information by phone or in person and documentation of the claimant's described job supports a finding of ability to perform past relevant work (PRW), do not document other past work. You can stop vocational development if the claimant has the ability to perform PRW. For detailed information about capacity for PRW, see

    • DI 25005.020 Past Relevant Work (PRW) as the Claimant Performed It

    • DI 25005.025 Past Relevant Work (PRW) as Generally Performed in the National Economy

  2. 2. 

    If documentation of other past work is necessary, fully develop each successive job until you identify a relevant job the claimant can perform.

2. Mail development

When you mail the SSA-3369-BK to the claimant, include a cover letter asking the claimant to document each job held during the five years before becoming unable to work because of their illnesses, injuries or conditions. You may print and send a partially completed SSA-3369-BK to assist the claimant. You may copy information from the SSA-3368 and paste it into an SSA-3369 to send a partially completed SSA-3369-BK to the claimant.

The “relevant period” is not always counted from the date of adjudication. You may advise the individual to address a specific period. For example, for title II claims with an entitlement period in the past, ask the claimant to document each job held during the five years prior to the entitlement period end date. For instructions on how to determine the relevant period for different types of claims, see DI 25001.001A.65.

Claimants are generally not familiar with our forms or with the way we use the work description. If the claimant’s completion of the mailed SSA-3369-BK is insufficient, take necessary actions described in DI 22515.030D in this section.

3. Medical-vocational profiles development

Gather details specific to the medical-vocational profiles early in the development process, when applicable. For information on medical-vocational profiles, see DI 25010.001.

Be alert for information showing the claimant might have:

  • 35 years or more of arduous unskilled work with no more than a marginal education (grade 6 or less) and a severe MDI(s) that prevents them from performing their past relevant work (PRW). In this situation, the claimant may meet the arduous unskilled work profile;

  • No past relevant work, age 55 or older, no more than a limited education (grade 11 or less), and a severe medical determinable impairment(s). In this situation, the claimant may meet the no work profile; or

  • 30 years or more in one job or field of work that is unskilled, or that is skilled or semi-skilled but provided no transferable skills, age of 60 or older, with no more than a limited education (grade 11 or less), and a severe MDI(s) that prevents them from performing their PRW. In this situation, the claimant may meet the lifetime commitment profile. For more information about transferable skills policy, see DI 25015.017.

If the claimant appears to meet the arduous work or lifetime commitment profile, their work history must be documented beyond the relevant five-year period.

4. Part-time work development

If the claimant has PRW that was part-time, and their RFC reflects an inability to sustain a 40-hour workweek, pursue targeted development about the work. This permits a function-by-function comparison of the claimant’s RFC and the requirements of their relevant part-time work. For more information about part-time work that is substantial gainful activity (SGA), see DI 24510.057B.4.

B. Description of form

1. Information about the disabled person (Section 1)

The SSA-3369-BK includes space for identifying information. (Get this information from the SSA-3368-BK or other form in file.)

NOTE: The Disability Determination Services (DDS) or the field office (FO) will complete the identifying information in every case in which completion of the SSA-3369-BK is required. For more information about completing the SSA-3369-BK see,

2. Information about work history (Section 2)

List all the jobs the claimant had in the five years before becoming unable to work because of their illnesses, injuries, or conditions. Section 2 provides space for the dates worked (From MM/YY, To MM/YY).

3. Subsections for each job (Section 2)

In each subsection, provide specific information about the work history listed on the SSA-3369-BK, or Section 6 of the SSA-3368-BK. Section 2 provides space for describing up to five past jobs. Each subsection asks specific information about:

  1. a. 

    rate of pay and hours of work per day and per week;

  2. b. 

    basic job duties;

  3. c. 

    use of machines, tools, or other equipment;

  4. d. 

    whether the claimant had to do any writing, or complete reports;

  5. e. 

    amount of bending, sitting, walking, or related activity;

  6. f. 

    amount, frequency, and duration of lifting, carrying, pushing or pulling;

  7. g. 

    other descriptive data providing a complete picture of the nature and duties of the job performed; and

  8. h. 

    any supervisory duties; and

  9. i. 

    interactions with coworkers, the general public, and others.

4. Remarks (Section 3)

Section 3 provides space for the claimant to continue their work history or to give any other information about their PRW. It also asks for the name of the person completing the form, if it is not the claimant.

C. DDS Processing of the 3369-BK

For instructions on how to complete the SSA-3369-BK, see DI 11005.025.

1. Section 1

Complete parts A, B, and C. This information should be available from the SSA-3368-BK or other file documents.

2. Section 2

Page 1

You do not need to ask the claimant to complete the work history chart on page 1 of section 2 if Section 6.A of the SSA-3368-BK is adequately completed. You may copy the information from the SSA-3368-BK into an SSA-3369-BK that you mail to the claimant.

Pages 2-7

Obtain detailed information for every job that is not adequately described elsewhere (such as on the SSA-3368-BK). If you request an SSA-3369 by mail and you already have an adequate description of a job, you may advise the claimant that he or she need not repeat that description.

If there is insufficient space on the form to describe the claimant’s work, use one or more additional SSA-3369-BKs or other continuation sheet.

NOTE: If more than, one SSA-3369-BK is used, complete identifying information in Section 1, and as much of Section 2 as is necessary. Mark the second form “Supplementary” at the top. If a different continuation sheet is used, identify it clearly.

3. Section 3 – Remarks

Provides space for the claimant to give any other information about their PRW.

4. Person completing the form

Request that the claimant or the person completing the form for the claimant print their name, address, date, and email address (optional) in the spaces provided in Section 3 of the form.

5. Follow up procedure

If the claimant refuses or fails to cooperate, see DI 23007.005 and DI 22505.014. For claimants who require special handling, see DI 23007.001A.

D. DDS review of the SSA-3369-BK

Review the SSA-3369-BK by checking that all items and questions requiring a response are completed. Even if the claimant is unable to give more than a nonspecific answer, such as, “I don't know” or “unknown” to a particular question or item involved, this assures that the claimant has not overlooked or omitted an item or question.)

After reviewing the SSA-3369-BK, telephone the claimant for further information, if needed. When you obtain additional information about a job, identify which job and which information you are modifying or supplementing.

Document any additional information in a Case Note in the Disability Case Processing System (DCPS) and "write to" the Case Development Worksheet.

NOTE: If more than one SSA-3369-BK is used, complete identifying information in Section 1, and as much of Section 2 and 3 as is necessary. Mark the second form “Supplementary” at the top. If a different continuation sheet is used, identify it clearly.

1. Resolving inconsistent information

Determine whether the information on the SSA-3369-BK is clear, consistent, and material to the determination. Clarify any inconsistent information material to the determination, including inconsistencies between work demands and the claimant’s narrative descriptions. Do not pursue additional development to make clarifications on inconsistencies that are not material to the disability determination. For instance, the total amount of time a claimant reports doing certain physical activities in a typical workday might exceed the total amount of time they report working in a typical day. These tasks do not need to always match the total hours worked because some tasks can be performed simultaneously. Further, inconsistent vocational information may not be material if the claimant does not have the residual functional capacity (RFC) to perform other aspects of the job.

For example, when the expedite procedure applies PRW information is not material. For information on the expedited vocational procedures, see DI 25005.005.

If the job duties described seem inconsistent with the claimant’s stated exertional demands, clarify and resolve the issue with the claimant if information about a particular job is material to the determination.

For example, the claimant states they spent all day collecting trash from individual offices and then dumping that trash into a large dumpster at the end of the day. However, they also state they performed no lifting as part of their job duties. Clarify this inconsistent information if the job is with in the claimant's RFC and the claimant’s ability to do that job, as described, is material to the determination. i.e., if they were required to collect trash by lifting it into the dumpster at the end of the day, lifting was part of their job duties.

2. 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. 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 they stood six hours and walked six hours in an eight-hour day that is likely an indication that they 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.


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DI 22515.030 - Use of Work History Report Form SSA-3369-BK - 06/21/2024
Batch run: 06/21/2024
Rev:06/21/2024