Work History Report

OMB 0960-0578

OMB 0960-0578

SSA collects the information to document an applicant's work history. The Disability Determination Services adjudicators use the information to make a decision about the alleged disability. The respondents are applicants for disability benefits.

The latest form for Work History Report expires 2021-01-31 and can be found here.

Latest Forms, Documents, and Supporting Material
OMB Details

Work History Report

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Form SSA-3369Work History ReportPaper OnlyForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.


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