Form SSA-3369-BK, the Work History Report, is used by the Social Security Administration (SSA) to gather detailed information about your work history over the past 15 years. This information helps the SSA determine eligibility for disability benefits by assessing how your past work experience relates to your current disability claim.

Individuals applying for Social Security Disability benefits who have worked in the past 15 years.

It is the Work History Report used by the SSA to assess your work history for disability claims.

It is not required if you haven't worked in the last 15 years or if your claim is solely based on medical records.

No, this form does not require a signature for submission.