Step 1: Understand the Purpose of the SSA-821-BK Form

The SSA-821-BK form asks for details about your past employment. The information you provide will help the SSA assess your work history and evaluate your eligibility for SSDI or SSI benefits.

The SSA uses this form to:

• Verify your work history.
• Determine if you meet the work credit requirements for SSDI.
• Assess your eligibility for disability benefits.

Step 2: Gather Required Information Before You Start

Before you begin filling out the SSA-821-BK form, gather the following documents:

• Job history: A list of all the jobs you’ve held in the past 15 years, including dates of employment, job titles, and employer names.
• Pay stubs or records: Proof of income from your previous jobs to show your work history and earnings.
• Medical records: These are essential if your disability has caused you to stop working, and you’re applying for SSDI or SSI.

Step 3: Completing Section 1: Personal Information

In this section, you will need to provide your personal details:

• Name: Fill in your full legal name as it appears on your Social Security card.
• Social Security Number (SSN): Enter your SSN as requested.
• Address: Provide your current address where the SSA can contact you.
• Date of Birth: Your birth date is needed to confirm your eligibility for disability benefits.
• Phone number: Include a number where you can be reached.

Step 4: Completing Section 2: Information About Your Work History

This section is the heart of the SSA-821-BK form. You must provide detailed information about the jobs you’ve had in the past 15 years. Follow these steps:

• Employer Name: List the name of each employer for whom you worked in the last 15 years.
• Dates of Employment: For each employer, provide the start date and end date of your employment.
• Job Title: Include your job title or the type of work you did.
• Duties Performed: Provide a description of the tasks and responsibilities you performed in each position. This helps the SSA understand whether your disability prevents you from performing the type of work you did.

If you had multiple positions with the same employer, list each job separately with the corresponding dates of employment and job duties.

Step 5:  Completing Section 3: Reason for Stopping Work

In this section, you must explain why you stopped working. The SSA is interested in knowing whether your disability is the reason you could no longer perform your job. You’ll need to answer the following:

• Why did you stop working?: Choose the reason that most closely matches your situation. This could be due to health problems, disability, or other reasons.
• Date you stopped working: Provide the exact date you stopped working because of your disability.

If you stopped working due to another reason (e.g., a job layoff or personal reasons), the SSA may ask for additional documentation to support your claim.

Step 6: Completing Section 4: Earnings During Employment

Here, you need to provide information about your earnings during each job listed in Section 2. This will help the SSA determine your eligibility for SSDI based on your work credits. You’ll need to list:

• Gross income: Enter your total earnings before any deductions (taxes, insurance, etc.) for each period of employment.
• Earnings records: You may need to provide pay stubs or other income documentation that confirms your gross earnings.

This section is essential for determining if you qualify for SSDI, as your earnings help the SSA assess whether you meet the work credit requirement.

Step 7: Completing Section 5: Other Work Information

If you performed any work that doesn’t fall under your regular employment (such as self-employment), you’ll need to provide details about that in Section 5. Be prepared to answer questions such as:

• Did you have a self-employed job? If yes, you’ll need to include information on how much you earned and the type of work you did.
• Were you involved in any volunteer work? This section is to clarify whether your income from self-employment or volunteer work was related to your disability claim.

Step 8: Completing Section 6: Certification

After you fill out the form, you must sign and date it, certifying that the information you provided is true and accurate. Make sure all sections are complete and that you have answered every question truthfully.

• Important Note: If you need assistance filling out the form, the SSA allows you to have someone help you, such as a representative or disability advocate. However, you must still sign the form yourself, as the SSA requires your personal verification.

Step 9: Submitting the SSA-821-BK Form

Once you’ve completed the form, double-check all of your answers. You can submit the SSA-821-BK form through the following methods:

• Online: If you’re applying for SSDI or SSI online, you can submit the form electronically.
• By mail: If you’re submitting the form separately, mail it to your local SSA office.
• In person: You can also visit a local SSA office to submit the form in person.

Step 10: Follow Up on Your Application

After submitting the SSA-821-BK, be sure to track the status of your disability application. You can call the SSA’s toll-free number (1-800-772-1213) or visit their website to check the status of your case and ensure that everything is proceeding smoothly.