Forms Used To Start A Claim For Social Security Disability
The primary forms that Social Security uses to start the application process for Social Security Disability Insurance are:
- Disability Report
- Adults use SSA-3368-BK (12-98) which can be obtained by clicking on http://www.socialsecurity.gov/forms/ssa-3368.pdf For information about completing this form, see Form SSA-3368-BK.
- Children under age 22 use Disability Report -- Child, SSA-3820-BK (12-98) which can be obtained by clicking on http://www.socialsecurity.gov/forms/ssa-3820.pdf
- Work History Report, SSA-3369-BK (7-98) located at http://www.socialsecurity.gov/forms/ssa-3369.pdf . For information about completing this form, see Form SSA-3369-BK.
- The Social Security Medical and Job Worksheet, Form SSA-3381. This form is mailed to all people who contact Social Security to set an appointment to start the Social Security Disability process. The worksheet is best used for people who are clearly entitled to be considered to be disabled. Otherwise, consider using the Work Activities Worksheet and the Daily Activities Worksheet, and answer the medical questions on Form SSA-3368-BK (noted above.) Also see Tips When Completing Medical Questionnaires. You can download a copy of the worksheet at: http://www.socialsecurity.gov/forms/ssa-3381.pdf
- Authorization To Disclose Information To The Social Security Administration: All applications for disability require several copies of the authorization form: Form SSA-827. The form is used to contact your doctors and other health care providers, and others who will give Social Security information about you to help decide your application for disability benefits. As you will see, the authorization is very broad. In addition to authorizing delivery of information about your impairment, it includes:
- Your treatments, hospitalization and outpatient care.
- Psychological, psychiatric or other mental impairments
- Drug abuse, alcoholism or other substance abuse
- Records which may indicate the presence of a communicable or venereal disease and
- Educational tests or evaluations.
The form also authorizes speaking with anyone who may know about your condition, including your employer, medical sources, family, neighbors and friends. The form can be obtained at http://www.socialsecurity.gov/forms/ssa-827.pdf Social security asks for a separate form for each place or person that will provide information.
- Application for Disability Insurance Benefits, SSA-16-F6 (9-99) (the content of which is located at http://www.socialsecurity.gov/forms/ssa-16.html . This form is for use by the interviewer. However, it is worth your reviewing so you will know what questions are going to be asked during the interview and you can be prepared to answer them. As you will see, the questions and answers are very straight forward.
- Supplementary Security Income (SSI): Starts with form SSA-8000-BK which can be located at http://www.ssa.gov/legislation/Attachment%20for%20SSA%20Testimony%207_25_12%20Human%20Resources%20Sub%20Hearing.pdf . For information aboutcompleting this form, see Supplemental Security Income (SSI).