OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Work History Report

OMB 0960-0578 · SSA.

OMB 0960-0578

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. We are submitting a non-substantive Change Request to include the Final Rule revisions currently approved under 0960-0834 (Intermediate Improvement to the Disability Adjudication Process, Including How We Consider Past Work) under this ICR. Upon OMB's approval of this Change Request (and the Change Requests for both 0960-0300 and 0960-0579), we will discontinue the ICR for 0960-0834 to avoid double-counting the burden for these information collections.

The latest form for Work History Report expires 2027-08-31 and is listed under ICR 202508-0960-004.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form SSA-3369 Work History ReportForm and Instruction
Justification for the Non-Substative Changes - 0578 (Moving Approved Changes from 0960-0834 to Associated ICR).docxJustification for No Material/Nonsubstantive Change
Supporting Statement - 0578 (Final).docxSupporting Statement A
Work History Report Form and Instruction
Work History Report Form and Instruction
Work History Report (EDCS) Other-SSA-3369 EDCS Screenshots -

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202508-0960-004 No material or nonsubstantive change to a currently approved collection 2026-03-23
202009-0960-011 Revision of a currently approved collection 2020-12-09
201701-0960-017 Revision of a currently approved collection 2017-05-17 Approved without change
201311-0960-009 Revision of a currently approved collection 2014-03-10 Approved without change
201007-0960-005 Revision of a currently approved collection 2010-12-10 Approved without change
200803-0960-002 No material or nonsubstantive change to a currently approved collection 2008-03-06 Approved without change
200702-0960-002 Revision of a currently approved collection 2007-07-25 Approved with change
200406-0960-004 Extension without change of a currently approved collection 2004-06-10 Approved with change
200106-0960-007 Revision of a currently approved collection 2001-06-14 Approved without change
199806-0960-001 Reinstatement with change of a previously approved collection 1998-06-02 Approved without change
199707-0960-008 New collection (Request for a new OMB Control Number) 1997-07-23 Approved without change

OMB Details

Work History Report

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Information collection instruments
FormNameElectronic accessType
Form SSA-3369Work History ReportFillable PrintableForm and instruction

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