Forms and Publications
Social Security Disability
We make every effort to ensure our forms are correct and up-to-date. We would appreciate being notified of any errors or newer versions of forms by email to [email protected].
The Social Security Disability process is often confusing, and finding answers difficult. We hope to help simplify the process by providing you the necessary forms in a fillable/saveable/printable format.
he publications available here are the same as those you will find at the Social Security website, and include all the forms you will receive from Social Security during the application process. They have been converted to a format that will allow you to type in the fields, make comments and print the forms for reference or submission. They include an auto-fill feature that will complete duplicate fields of the form with the previous information you entered.
We have also converted many of the Social Security on-line Handbooks into pdf format so you can easily search for anything you might need. They have been “user-enabled”, which allows yo to make comments and notes directly on the pdf and save for future reference.
Browse Forms by Category
Adult Application
- Required Forms
- Optional Forms
- SSI Eligibility (Coming Soon)
Child Application
Reconsideration and Appeals
Employment
Medicare
On-Going Reviews
- Reporting Requirements
- Continuing Disability Review
- Periodic Quality Review (Coming Soon)
- SSI Redetermination (Coming Soon)
- Overpayment
- Termination/Reinstatement
Post Approval
Adult Disability Application
Required Forms and Related Publications
| Form / Publication | Applies To | Form Type / Description | |
| SSDI | SSI | ||
|
Adult Starter Kit
|
x | x |
Actual Form
Used as Worksheet. Contains SSA-3381 and Checklist
|
|
Checklist - Adult Disability Interview
|
x | x |
Actual Form
Used as Worksheet. Contains SSA-3381 and Checklist
|
|
Medical and Job Worksheet - Adult
|
x | x |
Actual Form
Used as Worksheet. Contains SSA-3381 and Checklist
|
|
Application for Disability Insurance Benefits
|
x | Sample w/Fillable Fields | |
|
SSA-16-iClaim
(Coming Soon)Application for Disability Insurance Benefits
|
x |
Internet Submission
Screen shots of actual online application
|
|
|
Application for Supplemental Security Income
|
x | Actual Form | |
|
Authorization to Disclose Information
|
x | x | Actual Form |
|
Disability Report - Adult
|
x | x | Actual Form |
|
SSA-3368&69-iClaim
(Coming Soon)Disability & Work History Report - Adult
|
x | Internet Submission Screen shots of actual online application | |
|
Work History Report
|
x | Actual Form | |
|
SSDIPkg
(Coming Soon)
|
x | Contains all SSDI application forms in one package. | |
|
SSIPkg
(Coming Soon)
|
Contains all SSI application forms in one package. | ||
|
Disability Benefits
|
x | Related Publication | |
|
Apply Online For Social Security Benefits
|
x | Related Publication | |
|
How You Earn Credits
|
x | Related Publication | |
|
64-039
Disability Evaluation Under Social Security (Blue Book)
|
x | x | Related Publication |
Optional Forms and Related Publications
| Form / Publication | Applies To | Form Type / Description | |
| SSDI | SSI | ||
|
Statement of Claimant or Other Person
|
x | x | Actual Form May be initiated by applicant or third-party to provide additional information. |
|
Function Report - Adult
|
x | x | Actual Form DDS may request from Applicant |
|
Function Report - Adult - Third Party
|
x | x | Actual Form DDS may request from Third Party |
|
Request for Withdrawal of Application
|
x | Actual Form Initiated by Applicant to withdraw application | |
|
Claimant Travel Reimbrusement Request
|
x | x | Sample Form Mailed to Applicant by DDS when Consultive Exam (CE) is required |
|
Authorization to Release Medical Report to Physician
|
x | x | Sample Form Applicant may request from SSA if he/she wishes to have a copy of the CE mailed to personal physician |
|
A Special Examination Is Needed For Your Disability Claim
|
x | x | Related Publication |
|
Medical Report (General)
|
x | x | Sample Form DDS may request from Medical Provider and/or Consultant |
|
Physical Residual Functional Capacity Form
|
x | x | Sample Form DDS may request from Medical Provider and/or Consultant |
|
Report on Individual with Mental Impairment
|
x | x | Sample Form DDS may request from Medical Provider and/or Consultant |
|
Mental Residual Functional Capacity Form
|
x | x | Sample Form DDS may request from Medical Provider and/or Consultant |
|
Medical Consultant's Review of Mental Residual Functional Capacity Assessment
|
x | x | Sample Form Completed by Medical Consultant after review of sSA-4734-F4-SUP |
|
Consultative Examinations - A Guide for Health Professionals
|
x | x | Related Publication |
|
Answers for Doctors & Other Health Professionals
|
x | x | Related Publication |
|
Providing Medical Evidence to the Social Security Administration for Individuals with Chronic Fatigue Syndrome
|
x | x | Related Publication |
|
HIPAA and the Social Security Disability Programs
|
x | x | Related Publication |
|
A Fact Sheet for Mental Health Care Professionals
|
x | x | Related Publication |
|
If You Are Blind Or Have Low Vision—How We Can Help
|
x | x | Related Publication |
|
Social Security For People Living With HIV/AIDS
|
x | x | Related Publication |
|
Providing Medical Evidence For Individuals With HIV Infection
|
x | x | Related Publication |
|
Vocational Rehabilitation Providers Handbook
|
x | x | Related Publication |
|
Application for Child's Insurance Benefits
|
x | Sample w/Fillable Fields May be initiated by applicant to apply for Child's benefits | |
|
Child Relationship Statement
|
x | Actual Form May be initiated by applicant to certify responsibility for Child living in a different household. | |
|
Certificate of Responsibility for Welfare and Care of Child Not in Applicant's Custody
|
x | Actual Form May be initiated by applicant to certify responsibility for Child living in a different household. | |
|
Benefits For Children
|
x | Related Publication | |
|
Appointment of Representative
|
x | x | Actual Form May be initiated by Applicant to appoint a representative for dealing with SSA |
|
Petition to Obtain Approval of a Fee for Representing a Claimant Before the SSA
|
x | Actual Form Initiated by Appointed Representative to request approval of fee | |
|
Identifying Information for Possible Direct Payment of Authorized Fees
|
x | x | Actual Form |
|
Registration for Appointed Representative Services and Direct Payment
|
x | x | Actual Form Initiated by Appointed Representative as authorization to do business with SSA (Not savable) |
|
Your Right To Representation
|
x | x | Related Publication |
|
Modified Benefit Formula Questionnaire-Foreign Pension
|
x | Actual Form May be requested by SSA to report Foreign Pension | |
|
Supplement to Claim of Person Outside the United States
|
x | x | Actual Form SSA may request from Applicant |
|
Application for Benefits Under a U.S. International Social Security Agreement
|
x | Sample Form (Fillable Fields) Application to be used if living outside US | |
|
Military Service And Social Security
|
x | Related Publication | |
|
Disability Benefits For Wounded Warriors
|
x | Related Publication | |
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Expediting Disability Applications For Wounded Warriors
|
x | Related Publication | |
|
Modified Benefit Formula Questionnaire
|
x | Actual Form May be requested by SSA to report Windfall Elimination | |
|
Windfall Elimination Provision
|
x | Related Publication | |
|
Workers' Compensation Public Disability Benefit Questionnaire
|
x | Actual Form May be requested by SSA to report Worker's Compensation and other public disability benefits | |
|
Request for Worker's Compensation Public Disability Benefit Information
|
x | Sample Form SSA may request from third-party to verify benefits. | |
|
How Workers' Compensation and Other Disability Payments May Affect Your Benefits
|
x | Related Publication | |
|
Statement of Self-Employment Income
|
x | Sample Form SSA may request from self-employed applicant to establish minimum quarters of coverage | |
|
If You Are Self-Employed
|
x | Related Publication | |
Child Disability Application
Child Disability Report
| Form / Publication | Applies To | Form Type / Description | |
| SSDI | SSI | ||
|
Child Disability Report |
x |
Actual Form
To be completed after initial SSI Application |
|
|
Child Disability Report Online |
x | Internet Submission | |
Reconsideration and Appeals
Reconsideration
| Form / Publication | Applies To | Form Type / Description | |
| SSDI | SSI | ||
|
Request for Reconsideration |
x | x |
Actual Form
Initiated by Applicant to request reconsideration of disability decision |
|
Request For Reconsideration & Disability Report |
x | x |
Internet Submission
Initiated by Applicant to request reconsideration of disability decision. Internet version combines two paper forms
|
|
Disability Report - Appeal |
x | x |
Actual Form
Initiated by applicants / beneficiaries appealing disability determination, requesting hearing before hearing officer or ALJ |
|
Your Right To Question The Decision Made On Your Claim |
x | x | Related Publication |
|
The Appeals Process |
x | x | Related Publication |
Administrative Law Judge (ALJ)
| Form / Publication | Applies To | Form Type / Description | |
| SSDI | SSI | ||
|
Request For Hearing By Administrative Law Judge
|
x | x |
Actual Form
Initiated by applicant / beneficiary to request hearing before ALJ
|
|
Request For Hearing By Administrative Law Judge & Disability Report
|
x | x |
Internet Submission
Initiated by applicant / beneficiary to request hearing before ALJ. Internet version combines two paper forms
|
|
Request For Change In Time/Place Of Disability Hearing
|
x | x |
Sample Form
Initiated by Applicant or Beneficiary to request change of hearing.
|
|
Disability Report - Appeal
|
x | x |
Actual Form
May be requested from applicants / beneficiaries appealing disability determination, requesting hearing before hearing officer or ALJ
|
|
Claimant's Recent Medical Treatment
|
x | x |
Actual Form
May be requested from claimant to update medical record
|
|
Claimant's Medications
|
x | x |
Actual Form
May be requested from claimant to update medical record
|
|
Claimant's Work Background
|
x | x |
Actual Form
May be requested from claimant to update work history
|
|
Medical Source Statement Of Ability To Do Work-Related Activities (Physical)
|
x | x |
Sample Form
May be requested from Medical Provider or Consultant
|
|
Medical Source Statement Of Ability To Do Work-Related Activity (Mental)
|
x | x |
Sample Form
May be requested from Medical Provider or Consultant
|
|
Waiver Of Your Right To Personal Appearance Before An Administrative Lawjudge
|
x | x |
Actual Form
May be initiated by Applicant
|
|
Acknowledgement Of Receipt (Notice Of Hearing)
|
x | x |
Sample Form
Issued to claimant to acknowledge notice of hearing.
|
|
Acknowledgement Of Receipt (Notice Of Hearing)
|
x | x |
Sample Form
Issued to claimant to acknowledge notice of hearing.
|
|
Request To Decision Review Board To Vacate The Administrative Law Judge Dismissal Of Hearing
|
x | x |
Sample Form (Fillable)
Initiated by Claimant to request dismissal of ALJ be vacated.
|
|
Your Right To An Administrative Law Judge Hearing And Appeals Council Review Of Your Social Security Case
|
x | x | Related Publication |
|
Why You Should Have Your Hearing By Video
|
x | x | Related Publication |
Appeals Council
| Form / Publication | Applies To | Form Type / Description | |
| SSDI | SSI | ||
|
Request For Review Of Hearing Decision/Order
|
x | x |
Actual Form
Initiated by Applicant |
|
Notice Regarding Substitution Of Party Upon Death Of A Claimant |
x | x |
Actual Form
Inititiated by individual to substitute for deceased claimant. |
|
Request For Evidence From Doctor |
x | x |
Sample Form
May be requested from Medical Provider |
|
Request For Evidence From Hospital |
x | x |
Sample Form
May be requested from hospitals |
|
Your Right To An Administrative Law Judge Hearing And Appeals Council Review Of Your Social Security Case
|
x | x |
Related Publication |
Employment
Return to Work
| Form / Publication | Applies To | Form Type / Description | |
| SSDI | SSI | ||
|
Work Activity Report (Self-Employed Person)
|
x | x |
Actual Form
SSA may request from beneficiary to determine if work performed in self-employment is at SGA level.
|
|
Work Activity Report — Employee
|
x | x |
Actual Form
SSA may request from beneficiary to determine if work performed is at SGA level.
|
|
Letter To Employer Requesting Information About Wages Earned
|
x | x |
Sample Form
SSA may request from Employer to determine monthly benefits
|
|
Employer Report Of Special Wage Payments
|
x | x |
Actual Form
SSA may request from Employer to verify special wages
|
|
Employee Work Activity Report
|
x | x |
Actual Form
SSA may request from Employer when return to work has been unsuccessful.
|
|
How Work Affects Your Benefits
|
x | x | Related Publication |
|
Working While Disabled - How We Can Help
|
x | x | Related Publication |
|
If You Are Blind Or Have Low Vision—How We Can Help
|
x | x | Related Publication |
|
Red Book
|
x | x | Related Publication |
Expedited Reinstatement
| Form / Publication | Applies To | Form Type / Description | |
| SSDI | SSI | ||
|
Cover Letter
|
x | x |
Sample Letter
Issued by SSA to transmit SSA-371/372 for after unsuccessful return to work
|
|
Request For Reinstatement (Title II)
|
x |
Sample Form (Fillable Fields)
Initiated by former SSDI recipient to request expedited reinstatement
|
|
|
Request For Reinstatement (Title XVI)
|
x |
Sample Form (Fillable Fields)
Initiated by former SSI recipient no longer performing SGA
|
|
|
Continuing Disability Review Report
|
x | x |
Sample Form
Required to be submited with SSA-371 or SSA-372
|
|
Continuing Disability Review Report
|
x | x |
Sample Form
Required to be submited with SSA-371 or SSA-372
|
|
Authorization to Disclose Information
|
x | x | Actual Form |
Ticket to Work
| Form / Publication | Applies To | Form Type / Description | |
| SSDI | SSI | ||
|
SSA-1370
(Coming Soon)
Ticket To Work Individual Work Plan
|
x | x | Sample Form |
|
SSA-1375 (73&74)
(Coming Soon)
Ticket To Work Progress Review Form
|
x | x | Sample Form |
|
SSA-L1377
(Coming Soon)
Employer Progress Review
|
x | x | Sample Form |
|
Your Ticket To Work
|
x | x | Related Publication |
|
Your Ticket To Work - What You Need To Know To Keep It Working For You
|
x | x | Related Publication |
|
The Ticket To Work Program And Other Work Incentives
|
x | x | Related Publication |
|
Employment Networks In Social Security'S Ticket To Work Program
|
x | x | Related Publication |
|
SSA-1365
State Agency Ticket Assignment Form Ticket To Work And Self-Sufficiency Program
|
x | x |
Actual Form
Initiated by beneficiary wishing to assign Ticket to Work to a State VR program
|
|
SSA-4290
Development Of Participation In A Vocational Rehabilitation Or Similar Program
(Coming Soon)
|
x | x |
Sample Form
Completed by State VR programs to document beneficiary's participation in VR program
|
Plan to Achieve Self-Support (PASS)
| Form / Publication | Applies To | Form Type / Description | |
| SSDI | SSI | ||
|
Plan To Achieve Self-Support |
x | Actual Form | |
|
Working While Disabled—A Guide To Plans For Achieving Self-Support |
x | Related Publication | |
|
A Guide To Preparation Of The Plan To Achieve Self-Support (Pass) Application FormFor People Who Are Blind Or Visually Impaired |
x | Related Publication | |
Medicare
General Information
| Form / Publication | Applies To | Form Type / Description | |
| SSDI | SSI | ||
|
Medicare |
x | Related Publication | |
|
Understanding The Benefits |
x | Related Publication | |
|
Medicare & You |
x | Related Publication | |
|
Important Information For Tricare (Military Health Benefits) Beneficiaries Entitled To Medicare Based On Social Security Disability
|
x | Related Publication | |
Part B
| Form / Publication | Applies To | Form Type / Description | |
| SSDI | SSI | ||
|
Medicare Part B Income-Related Premium - Life-Changing Event
|
x |
Actual form
Initiated by enrollee when life-changing event may reduce payment
|
|
|
SSA-44-I
Medicare Part B Income-Related Premium - Life-Changing Event
|
x |
Interview
Initiated by enrollee when life-changing event may reduce payment
|
|
|
Authorization For Ssa To Obtain Account Records From A Financial Institution And Request For Records (Medicare) (As Completed By The Claimant.)
|
x |
Sample Form (Fillable)
SSA may request for Third-Party Verification
|
|
|
Authorization For Ssa To Disclose Tax Information For Your Appeal Of Your Medicare Part B Income-Related Monthly Adjustment Premium Amount
|
x |
Actual Form
SSA may request for Third-Party Verification
|
|
|
Medicare Part B Premiums - Important Information For People Newly Eligible For Medicare
|
x | Related Publication | |
|
Medicare Part B Premiums: Rules For Beneficiaries With Higher Incomes
|
x | Related Publication | |
|
Medicare Part B Premiums - Rules For Beneficiaries With Higher Incomes FAQ
|
x | Related Publication | |
|
Medicare Part B Premiums - What You Can Do If You Think Your Medicare Part B Income-Related Premium Is Incorrect
|
x | Related Publication | |
|
Medicare Annual Verification Notices: Frequently Asked Questions
|
x | Related Publication | |
Part D
| Form / Publication | Applies To | Form Type / Description | |
| SSDI | SSI | ||
|
Application For Help With Medicare Prescription Drug Plan Costs
|
x | Sample Form | |
|
Application For Help With Medicare Prescription Drug Plan Costs
|
x | Internet Submission | |
|
Appeal Of Determination For Extra Help With Medicare Prescription Drug Plan Costs
|
x | Actual Form | |
|
SSA-1021-i
(Coming Soon)
Appeal Of Determination For Extra Help With Medicare Prescription Drug Plan Costs (Interview)
|
x | Interview | |
|
Changes In The Law Could Make More People Eligible For Extra Help In 2010
|
x | Related Publication | |
|
Getting Extra Help With Medicare Prescription Drug Plan Costs - Resource And Income Limits
|
x | Related Publication | |
|
Getting Extra Help With Medicare Prescription Drug Plan Costs. Information For Medicare Beneficiaries With Disabilities
|
x | Related Publication | |
|
Tips For Completing The Application For Extra Help With Medicare Prescription Drug Plan Costs
|
x | Related Publication | |
|
What You Need To Complete The Application For Extra Help With Medicare Prescription Drug Plan Costs
|
x | Related Publication | |
|
Your Right To Question The Decision On Your Application For Help With Medicare Prescription Drug Plan Costs
|
x | Related Publication | |
|
Help Someone Save An Average Of $3,900 On Prescription Drug Costs
|
x | Related Publication | |
|
Understanding The Extra Help With Your Medicare Prescription Drug Plan
|
x | Related Publication | |
|
It'S Easier Than Ever To Save On Your Prescription Costs
|
x | Related Publication | |
|
Medicare Part D Extra Help
|
x | Related Publication | |
|
SSA-1026-OCR-SM
Social Security Administration Review Of Your Eligibility For Extra Help
|
x |
Sample Form
Periodic Quality Review
|
|
|
SSA-8510
(Coming Soon)
Authorization For The Social Security Administration To Obtain Personal Information
|
x |
Sample Form
Periodic Quality Review
|
|
|
Review Of Your Eligibility For Extra Help With Medicare Prescription Drug Plan Costs: Some Things You Should Know
|
x |
Related Publication
Sample Form
|
|
On-Going Reviews
Reporting Requirements
| Form / Publication | Applies To | Form Type / Description | |
| SSDI | SSI | ||
|
Reporting Changes That Affect Your Social Security Payment
|
x | x | Sample Form (Fillable) |
|
Report Of New Information In Disability Cases
|
x | Sample Form | |
|
SSA-8150-EV
(Coming Soon)
Reporting Events, Ssi
|
x | Sample Form | |
|
Advance Notice Of Termination Of Child's Benefits
|
x |
Actual Form
Issued in advance of child turning 18 to determine eligibility for Student Benefits
|
|
|
Student Reporting Form
|
x | Sample Form | |
|
Reporting Your Wages When You Receive Supplemental Security Income (SSI)
|
x | Related Publication | |
|
Monthly Wage Reporting And Supplemental Security Income (SSI) For Sheltered Workshops
|
x | Related Publication | |
Continuing Disability Review (CDR)
| Form / Publication | Applies To | Form Type / Description | |
| SSDI | SSI | ||
|
Continuing Disability Review Report
|
x | x |
Sample Form
Required of all beneficiaries when their reexamination is due.
|
|
Continuing Disability Review Report
|
x | x |
Sample Form
The paper BK version is slowly being phased out and replaced by this IRC version
|
|
Disability Update Report
|
x | x |
Sample Form
SSA-455 is slowly being phased out and replaced by this OCR version
|
|
What You Need To Know - Reviewing Your Disability
|
x | x | Related Publication |
|
How We Decide If You Are Still Disabled
|
x | x | Related Publication |
|
Disability Evaluation Under Social Security (Blue Book)
|
x | x | Related Publication |
|
Function Report - Adult
|
x | x |
Actual Form
DDS may request from Applicant
|
|
Physical Residual Functional Capacity Form
|
x | x |
Sample Form
DDS may request from Medical Provider and/or Consultant
|
|
Mental Residual Functional Capacity Form
|
x | x |
Sample Form
DDS may request from Medical Provider and/or Consultant
|
|
Claimant Travel Reimbrusement Request
|
x | x |
Sample Form
Mailed to Applicant by DDS when Consultive Exam (CE) is required
|
|
Medical Consultant's Review of Mental Residual Functional Capacity Assessment
|
x | x |
Sample Form
Completed by Medical Consultant after review of sSA-4734-F4-SUP
|
|
Authorization to Release Medical Report to Physician
|
x | x |
Sample Form
Applicant may request from SSA if he/she wishes to have a copy of the CE mailed to personal physician
|
|
A Special Examination Is Needed For Your Disability Claim
|
x | x | Related Publication |
|
Consultative Examinations - A Guide for Health Professionals
|
x | x | Related Publication |
|
Answers for Doctors & Other Health Professionals
|
x | x | Related Publication |
|
Providing Medical Evidence to the Social Security Administration for Individuals with Chronic Fatigue Syndrome
|
x | x | Related Publication |
|
HIPAA and the Social Security Disability Programs
|
x | x | Related Publication |
|
A Fact Sheet for Mental Health Care Professionals
|
x | x | Related Publication |
|
Cessation Or Continuance Of Disability Or Blindness Determination And Transmittal
|
x | x |
Sample Form
Completed by state DDS to document determination of continued eligibility
|
|
Your Right To Question The Decision To Stop Your Disability Benefits
|
x | x | Related Publication |
|
The Appeals Process
|
x | x | Related Publication |
|
64-048
Childhood Disability-SSI Program - Guide for Physicians
|
Child | Related Publication | |
|
64-049
Childhood Disability-SSI Program - Guide for School Professionals
|
Child | Related Publication | |
Overpayment
| Form / Publication | Applies To | Form Type / Description | |
| SSDI | SSI | ||
|
Important Information About Your Appeal, Waiver Rights, And Repayment Options
|
x | x |
Sample Form (Fillable)
Initiated by SSA describing beneficiary's rights.
|
|
Request For Waiver Of Overpayment Recovery Or Change In Repayment Rate |
x | x |
Actual Form
Initiated by Beneficiary to contest overpayment. |
|
Overpayments |
x | x |
Related Publication |
Termination / Reinstatement
| Form / Publication | Applies To | Form Type / Description | |
| SSDI | SSI | ||
|
Response To Notice Of Revised Determination
|
x | x |
Sample Form
Initiated by recipient in response to notice of disability cessation. Must be requested from SSA.
|
|
Notice Regarding Substitution Of Party Upon Death Of Claimant--Reconsideration Of Disability Cessation
|
x | x |
Sample Form
Initiated by substitute party on behalf of deceased recipient to request reconsideration of disabilitycessation.
|
|
Request For Reconsideration - Disability Cessation
|
x | x | Actual Form |
|
Disability Report - Appeal
|
x | x |
Actual Form
May be requested from applicants / beneficiaries appealing disability determination, requesting hearing before hearing officer or ALJ
|
|
SSA-3441-I
Disability Report - Appeal (Internet)
|
x | x |
Internet Submission
May be requested from applicants / beneficiaries appealing disability determination, requesting hearing before hearing officer or ALJ
|
|
Request For Change In Time/Place Of Disability Hearing
|
x | x |
Sample Form (Fillable)
Initiated by Applicant or Beneficiary to request change of hearing.
|
|
Waver Of Right To Appear--Disability Hearing
|
x | x |
Sample Form (Fillable)
Initiated by Applicant or Beneficiary.
|
|
Your Right To Question The Decision Made On Your Claim
|
x | x | Related Publication |
Post Approval
General Information
| Form / Publication | Applies To | Form Type / Description | |
| SSDI | SSI | ||
|
What You Need To Know When You Get Social Security Disability Benefits
|
x | Related Publication | |
|
What You Need To Know When You Get Supplemental Security Income (SSI)
|
x | Related Publication | |
|
Direct Deposit Sign-Up Form
|
x | x | Actual Form |
|
Get Your Payment Through The Direct Express Card
|
x | x | Related Publication |
|
Moving? Save Time - Change Your Address Online
|
x | x | Related Publication |
|
Consent For Release Of Information
|
x | x |
Actual Form
May be used to request personal records through FOIA
|
|
How Are We Doing?
|
x | x | Actual Form |
|
Complaint Form For Allegations Of Discrimination In Programs Or Activities Conducted By The Social Security Administration
|
x | x | Actual Form |
|
How To File An Unfair Treatment Complaint
|
x | x | Related Publication |
|
Food Stamps And Other Nutrition Programs
|
x | Related Publication | |
|
Food Stamp Facts
|
x | Related Publication | |
Appointed Representative
| Form / Publication | Applies To | Form Type / Description | |
| SSDI | SSI | ||
|
Your Right To Representation
|
x | x | Related Publication |
|
Appointment of Representative
|
x | x |
Actual Form
May be initiated by Applicant to appoint a representative for dealing with SSA
|
|
Petition to Obtain Approval of a Fee for Representing a Claimant Before the SSA
|
x |
Actual Form
Initiated by Appointed Representative to request approval of fee
|
|
|
Identifying Information for Possible Direct Payment of Authorized Fees
|
x | x |
Actual Form
Initiated by Appointed Representative to request direct deposit of fee
|
|
Registration for Appointed Representative Services and Direct Payment
|
x | x |
Actual Form
Initiated by Appointed Representative as authorization to do business with SSA (Not savable)
|
Payee Representative
| Form / Publication | Applies To | Form Type / Description | |
| SSDI | SSI | ||
|
When A Representative Payee Manages Your Money
|
x | x | Related Publication |
|
A Guide For Representative Payees
|
x | Related Publication | |
|
Request To Be Selected As Payee
|
x | x | Actual Form |
|
SSA-11-BK-I
Request To Be Selected As Payee - Interview
|
x | x | Interview |
|
Statement Of Care And Responsibility For Beneficiary
|
x | x | Sample Form |
|
Physician'S/Medical Officer'S Statement Of Patient'S Capability To Manage Benefits
|
x | x | Actual Form |
|
Beneficiary Interview & Auditor's Observations
|
x | x |
Sample Form
Randomly selected interview of beneficiaries to determine if payee is properly complying with responsibilities
|
|
Expanded Monitoring Site Review Questionnaire For Volume And Fee For Service Payees
|
x | x |
Sample Form
Randomly selected audit of representive payees
|
|
Expanded Monitoring Site Review Beneficiary Review Form
|
x | x |
Sample Form
Randomly selected audit of representive payees
|
Living Outside the U.S.
| Form / Publication | Applies To | Form Type / Description | |
| SSDI | SSI | ||
|
Your Payments While You Are Outside The United States
|
x | x | |
|
Questionnaire About Employment Or Self-Employment Outside The United States
|
x | x | Actual Form |
|
Report To United States Social Security Administration By Person Receiving Benefits For A Child Or An Adult Unable To Handle Funds
|
x | x |
Actual Form
To monitor Payee Representatives living outside United States
|
|
Report To The United States Social Security Administration
|
x | x |
Sample Form (Fillable)
To determinine continuing eligibility while living outside U.S.
|
|
Supplement to Claim of Person Outside the United States
|
x | x |
Sample Form
SSA may request from Applicant
|