Disability doctors medical form

Social Security offers an online disability application you can complete at your convenience. Apply from the comfort of your home or any location at a time most convenient for you. You do not need to drive to your local Social Security office or wait for an appointment with a Social Security representative.

You can use the online application to apply for disability benefits if you:

• Are age 18 or older;
• Are not currently receiving benefits on your own Social Security record;
• Are unable to work because of a medical condition that is expected to last at least 12 months or result in death: and
• Have not been denied disability benefits in the last 60 days. If your application was recently denied for medical reasons, the Internet Appeal is a starting point to request a review of the medical determination we made.

Here is what you need to do to apply for benefits online:

• Print and review the Adult Disability Checklist.
  It will help you gather the information you need to complete the application.
• Complete the Disability Benefit Application.

We suggest that you have the following information at hand. It will make completing the application much easier.

Information About You

• Your date and place of birth and Social Security number
• The name, Social Security number and date of birth or age of your current spouse and any former spouse. You should also know the dates and places of marriage and dates of divorce or death (if appropriate)
• Names and dates of birth of your minor children
• Your bank or other financial institution's Routing Transit Number [more info] and the account number, if you want the benefits electronically deposited

Information About Your Medical Condition

• Name, address and phone number of someone we can contact who knows about your medical conditions and can help with your application
• Detailed information about your medical illnesses, injuries or conditions:
  • Names, addresses, phone numbers, patient ID numbers and dates of treatment for all doctors, hospitals and clinics;
  • Names of medicines you are taking and who prescribed them; and
  • Names and dates of medical tests you have had and who sent you for them.

  Information About Your Work

  • The amount of money earned last year and this year
  • The name and address of your employer(s) for this year and last year
  • A copy of your Social Security Statement
  • The beginning and ending dates of any active U.S. military service you had before 1968
  • A list of the jobs (up to 5) that you had in the 15 years before you became unable to work and the dates you worked at those jobs
  • Information about any workers' compensation, black lung, and/or similar benefits you filed, or intend to file for. These benefits can:
    • Be temporary or permanent in nature;
    • Include annuities and lump sum payments that you received in the past;
    • Be paid by your employer or your employer's insurance carrier, private agencies, or Federal, State or other government or public agencies; and
    • Be referred to as:
      1. Workers' Compensation;
      2. Black Lung Benefits;
      3. Longshore and Harbor Workers' Compensation;
      4. Civil Service (Disability) Retirement;
      5. Federal Employees' Retirement;
      6. Federal Employees' Compensation;
      7. State or local government disability insurance benefits; or
      8. Disability benefits from the military (This includes military retirement pensions based on disability but not Veterans' Administration (VA) benefits.)

    We may ask you to provide documents to show that you are eligible, such as:

    • Birth certificate or other proof of birth;
    • Proof of U.S. citizenship or lawful alien status if you were not born in the United States [more Info];
    • U.S. military discharge paper(s) if you had military service before 1968;
    • W-2 forms(s) and/or self-employment tax returns for last year;
    • Medical evidence already in your possession [more info]. This includes medical records, doctors' reports, and recent test results; and
    • Award letters, pay stubs, settlement agreements or other proof of any temporary or permanent workers' compensation-type benefits you received [more info].

    Important

    We accept photocopies of W-2 forms, self-employment tax returns or medical documents, but we must see the original of most other documents, such as your birth certificate. (We will return them to you.)

    Do not delay applying for benefits because you do not have all the documents. We will help you get them.

    Mailing Your Documents

    If you mail any documents to us, you must include the Social Security number so that we can match them with the correct application. Do not write anything on the original documents. Please write the Social Security number on a separate sheet of paper and include it in the mailing envelope along with the documents.

    If you do not want to mail these documents, you may bring them to a Social Security office. Do not mail foreign birth records or any documents from the Department of Homeland Security (DHS), formerly the Immigration and Naturalization Service (INS), especially those you are required to keep with you at all times. These documents are extremely difficult, time-consuming and expensive to replace if lost. Some cannot be replaced. Instead, bring them to a Social Security office where we will examine them and return them to you.

    Our online disability application process offers several advantages. You can:

    • Start your disability claim immediately. There is no need to wait for an appointment.
      
    • Apply from the convenience of your own home or on any computer.
      
    • Stop and return to your saved application before submission.
      
    • Avoid trips to a Social Security office.
      
    • Complete the process online even if you live outside the United States.
      

    After we receive your online application, we will:

    • Provide confirmation of your application- either electronically or by mail.
      
    • Review the application.
      
    • Contact you if we need more information or documentation.
      
    • Inform you if other family members may be able to receive benefits on your record, or if you may be able to receive benefits on another person’s record, such as your spouse or your parent.
      
    • Process your application.
      
    • Mail our decision to you.
      

    You can also apply:

    • By phone - Call us at 1-800-772-1213 from 7 a.m. to 7 p.m. Monday through Friday. If you are deaf or hard of hearing, you can call us at TTY 1-800-325-0778.
      
    • In person - Visit your local Social Security office. (Call first to make an appointment.)

    If you do not live in the U.S. or one of its territories, you can also contact your nearest Federal Benefits Unit that provides service to your country of residence.

    Publications

    • Apply Online for Disability Benefits
    • Disability Benefits
    • Fact Sheet – Exclusion of Certain Medical Sources’ Evidence

    Related Information

    • Disability Planner
    • Information for Representatives
    • What You Need to Know About The Online Disability Application
    • Helping Someone Apply Online
    • Information on Excluding Certain Medical Sources' Evidence

    What about SSI?

    Supplemental Security Income (SSI) pays benefits to disabled adults and children with limited income and resources.