Effective Dates: 6/22/2024 - Present

Identification Number:
DI 11005 TN 110
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Disability Interviews
Type:POMS Full Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM

Part DI – Disability Insurance

Chapter 110 – Initial Claims Processing

Subchapter 05 – Disability Interviews

Transmittal No. 110, 06/21/2024

Audience

PSC: CA, CS, DE, DEC, DTE, ICDS, IES, ISRA, RECONR, SCPS, TSA, TST;
OCO-OEIO: BET, CR, CTE, ERE, FCR, FDE, FDEC, RECONE, RECONR, RECOVR;
FO/WSU/TSC: CS, CS TII, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;
OCO-ODO: BET, BTE, CR, CST, CTE, CTE TE, DE, DEC, DS, PAS, PETE, PETL, RCOVTA, RECONE, RECOVR;
ODD-DDS: REF;

Originating Component

ODP

Effective Date

06/22/2024

Background

ODP is revising the instructions for completing the form SSA-3369 in time for the publication of SSA's final rule changing the relevant work period for past relevant work from 15 years to 5 years. In addition to updating references to the relevant work period, updating the instructions for consistency with forms updates. This is a simultaneous publication to conform to the PRW Final Rule effective 06/22/2024. Hold for publication on 06/21/2024 with an effective date of 06/22/2024.

Summary of Changes

DI 11005.025 Completing the SSA-3369

  • •

    We changed the relevant work period from 15 years to 5 years.

  • •

    We added gender neutral language replacing his/hers with their/theirs.

  • •

    We revised instructions for consistency with the most current OMB forms package.

DI 11005.025 Completing the SSA-3369

A. Introduction

The SSA-3369-BK is used to supplement the SSA-3368-BK to obtain detailed work information when a claimant has performed more than one job in the relevant work period.

B. Policy for completing the SSA-3369

1. When to complete the form

The FO must complete an SSA-3369-BK only for someone who

  • •

    is homeless; or

  • •

    will be difficult to contact by telephone; or

  • •

    will be unavailable for contact (e.g., may be on an extended trip).

2. When NOT to complete the form

The FO does not complete the SSA-3369-BK when

  1. a. 

    SSA-3368-BK curtailment is applicable, see DI 11005.020.

  2. b. 

    the claimant had only one job in the past relevant work period before becoming unable to work because of their medical conditions.

C. Procedure for completing the SSA-3369

1. Section 1 - Information about the disabled person

  1. a. 

    Record basic identifying information about the claimant (name, Social Security Number).

  2. b. 

    Indicate the telephone number where the claimant can be reached, or the number where a message can be left.

2. Section 2 - Work history

Record information about all the jobs the claimant had in the five years before becoming unable to work because of their medical condition(s), starting with their most recent job first.

Include all job titles (even if they were for the same employer), self-employment, and work performed in a foreign country. Do not include jobs held for less than one month.

IMPORTANT: Some jobs may be performed differently from employer to employer. Therefore, it may be necessary to provide separate descriptions for the same job title when the work was for a different employer. For example, if the claimant was a "cashier" at three different businesses and the job duties differed in each job, include three separate descriptions in the job table. If the job duties and the physical and mental requirements were the same, one entry is sufficient.

For each job, record:

  • •

    Job title: Enter the type of job performed. For example, "cashier."

  • •

    Type of business: For example, enter "grocery store" instead of the business name.

  • •

    Dates worked: Enter the month and year the claimant worked in this job.

  • •

    Hours per day: Enter the hours worked per day.

  • •

    Days per week: Enter the number of days worked per week.

  • •

    Rate of pay: Enter the Rate of pay and frequency. For example, if the claimant earned $12.00 per hour, enter $12.00 in the "Rate of pay" field and check the frequency "hourly."

  • •

    Whether the claimant's job involved writing or completing reports.

  • •

    The physical and environmental requirements of each job. For example: how much bending, sitting, walking, or related activity was required.

  • •

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

  • •

    any supervisory duties.

3. Section 3 – Remarks

Use Section 3 to document any additional information or explanation the claimant did not give in other sections of this report. If you did not have enough space in previous sections of this report to provide all the requested information, use this space to provide the additional information. Be sure to include the job title number to which you are referring.

NOTE: If there is insufficient space on the form to include all jobs, use an additional SSA-3369(s). When more than one form is used, complete ONLY the claimant's name and SSN on the front page of all additional forms. Mark “Supplementary” at the top of the additional form(s). Draw a line through any section of the form that is not being completed.


DI 11005 TN 110 - Disability Interviews - 6/22/2024