TN 4 (08-20)
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.
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Subject
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When Required
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Application
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Always for Disability Insurance Benefit (DIB) and/or freeze
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Disability
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Required for entitlement. Not necessary if claim is disallowed on other grounds.(See
DI 11005.001 and DI 11010.035)
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Disability Insured Status
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Required for entitlement. Not necessary if the claim is disallowed on other grounds.
(See DI 10105.145 and DI 11010.035)
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SSA-3368-BK ( Disability Report – Adult) or electronic equivalent
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If disability is developed.
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SSA-827 (Authorization For Source To Release Information To The Social Security Administration)
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Completed for all disability claims and in non-disability claims in which capability
is an issue.
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Proof-of-Age
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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.)
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When the Primary Insurance Amount (PIA) or insured status (Including the special age
31 test) would be affected
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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).
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SSA-3369 (Work History Report) or electronic equivalent
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When the conditions in DI 11005.025B are met.
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Selection of Representative Payee
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If the NH is incapable of handling his/her funds (See GN 00502.001).
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SSA-21 (Supplement to Claim of Person Outside the United States)
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If claimant lives outside the U.S. or intends to leave the U.S. (See GN 00205.180).
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