BASIC (06-06)

DI 10105.085 Summary of Evidence and Forms Required

The following chart provides a list of the most commonly required forms and proofs needed for most disability claims. This chart is not all-inclusive.

Subject

When Required

Application

Always for Disability Insurance Benefit (DIB) and/or freeze

Disability

Required for entitlement. Not necessary if claim is disallowed on other grounds.(See DI 11005.001 and DI 11010.035)

Disability Insured Status

Required for entitlement. Not necessary if the claim is disallowed on other grounds. (See DI 10105.145 and DI 11010.035)

SSA-3368-BK ( Disability Report – Adult) or electronic equivalent

If disability is developed.

NOTE: Under the jurisdiction of Collateral Estoppel the SSA-3368-BK does not need to be prepared for cases if a full disability determination is being adopted (e.g., partial award not involved) and a Disability Determination Service (DDS) determination is not needed. (See DI 11011.001B.)

SSA-827 (Authorization For Source To Release Information To The Social Security Administration)

Completed for all disability claims and in non-disability claims in which capability is an issue.

Proof-of-Age

  • When the claimant is within 6 months of age 55 or older and is filing under the special blind provisions (See DI 11010.055 and DI 10105.065.)

  • When the Primary Insurance Amount (PIA) or insured status (Including the special age 31 test) would be affected

  • When the evidence establishes the number holder (NH) has attained at least age 62, but has not attained full retirement age (FRA) in or before the first month of potential DIB entitlement. In this case the field office (FO) would contact the claimant to discuss benefit alternatives that are available (See DI 11010.060).

SSA-3369 (Work History Report) or electronic equivalent

When the conditions in DI 11005.025B. are met.

Selection of Representative Payee

If the NH is incapable of handling his/her funds (See GN 00502.001).

SSA-21 (Supplement to Claim of Person Outside the United States)

If claimant lives outside the U.S. or intends to leave the U.S. (See GN 00205.180).


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http://policy.ssa.gov/poms.nsf/lnx/0410105085
DI 10105.085 - Summary of Evidence and Forms Required - 03/21/2017
Batch run: 03/21/2017
Rev:03/21/2017