OMB control number
Work History Report
OMB 0960-0578 · SSA.
SSA asks individuals applying for disability about work they performed in the past. Applicants use Form SSA-3369, Work History Report, to provide SSA with detailed information about applicant’s jobs held prior to becoming unable to work. State Disability Determination Services evaluate the information together with medical evidence, to determine eligibility for disability payments. The respondents are disability applicants and third parties assisting applicants.
The latest form for Work History Report expires 2027-08-31 and can be found here.
Work History Report | No material or nonsubstantive change to a currently approved collection | 2026-03-23 | ||
| Revision of a currently approved collection | 2020-12-09 | ||
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Approved without change |
Revision of a currently approved collection | 2017-05-17 | |
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Approved without change |
Revision of a currently approved collection | 2014-03-10 | |
|
Approved without change |
Revision of a currently approved collection | 2010-12-10 | |
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Approved without change |
No material or nonsubstantive change to a currently approved collection | 2008-03-06 | |
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Approved with change |
Revision of a currently approved collection | 2007-07-25 | |
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Approved with change |
Extension without change of a currently approved collection | 2004-06-10 | |
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Approved without change |
Revision of a currently approved collection | 2001-06-14 | |
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Approved without change |
Reinstatement with change of a previously approved collection | 1998-06-02 | |
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Approved without change |
New collection (Request for a new OMB Control Number) | 1997-07-23 |
Work History Report
Federal Enterprise Architecture: Income Security - General Retirement and Disability
| Form SSA-3369 | Work History Report | Fillable Printable | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.