Ask the claimant if anyone else (other than their healthcare providers) has their medical information.
Examples include Department of Veterans Affairs, workers’ compensation, vocational
rehabilitation agencies, insurance companies, prisons, attorneys, social service agencies,
and welfare.
If “No” and the claimant is receiving Supplemental Security Income (SSI) and has been asked
to complete this report, go to Section 10. If not, go to Section 11.
If “Yes,” collect the following information:
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Address, City, State/Province, ZIP/Postal code, and Country (if not USA)
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Name of contact person and claim number (if any)
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Date of first contact, date of last contact, date of next contact (if any), and the
reasons for contacts. If the claimant is unable to remember the exact dates, obtain
approximate dates.
If the claimant indicates they receive, or received, support(s) from a social services
agency, vocational rehabilitation agency, or other type of support service for a job
listed in Section 6, document the agency or organization that helped them go to work.
If you need more space, use Section 11 – Remarks. For more information on supported
employment, see DI 10505.025D.
For additional information about locating prison records, follow procedures in GN 02607.520 PUPS Skeleton Record and DI 10105.094 Field Offices Identifying and Documenting Prisoner Status for Title II Disability
Benefits.
If you need to list other people or organizations, use Section 11 – Remarks.