DISABILITY CLAIM CHECKLIST

Filing a Social Security disability claim is a complex matter.  The Forsythe Firm offers this checklist to help claimant's properly file their claim for best potential results:

Initial Application (First Time Filing) - You will need to complete the following forms

• Application for Benefits (online or at a Social Security office)
• Disability Report (Adult/Child) - Form SSA-3368 BK
• Function Report - Form SSA-3373-BK
• Work History Report - Form SSA-3369 BK
• Authorization to Release information to the Social Security Administration (SSA-827) 

Additional forms may be sent to you by the Disability Determination Service after your application is submitted.

Appeal / Request for Hearing by Administrative Law Judge - You need the following:

• Request for Hearing by Administrative Law Judge - Form HA-501
• Disability Report (Appeal) - Form SSA-3441
• Authorization to Release Information to the Social Security Administration - Form SSA-827 

Some Important Information You Will Need to File an Initial Claim 

• Contact information:  Name, address, phone no., SSN, alternate phone number 
• Name, address, phone of a family member or alternate contact
• Marriage information:  name, DOB, SSN for current and former spouse(s), date of marriage, location of marriage, date and location of any divorce(s)
• A list of employers and job titles you have held in the past 15 years, details to include rate of pay, date hired, date left company, etc.
• A list of all physical and mental impairments, whether or not they are severe
• List of names, address, phone for all doctors, hospitals, therapists, clinics and other medical providers; go back at least 1 year, longer for serious, chronic ailments; give first/last date each provider was seen, name of condition each provider treated; name of any tests from each provider with dates.
• List of all medications you now take and the name of the doctor who prescribes them.
• Exact date you last worked. 
• The exact date you claim to have first become disabled (called the Alleged Onset Date or AOD - very important for this determines your back pay.
• Details of any money paid by your employer since your last date at work--such as pension plan, sick leave, vacation pay, long term disability payments, workers compensation, etc. 
• For SSI claims (Title XVI) only:  You will need proof of income for each person living in your household.   

As you can probably gather from this list, it will require several hours of work to find all of the information and complete all of the forms necessary to file a complete Social Security disability claim.  A Social Security office can provide forms and assist with the mechanical aspect of completing the forms.  The Social Security office, however, will not act as your advocate or representative.