MAKE YOUR FREE Social Security Application Worksheet
What is a Social Security Application Worksheet?
Using a Social Security Application Worksheet can help make applying for disability or retirement benefits a little easier. Keeping track of what benefits you need, and what information you need ready to claim them, can be a challenge, but this easy checklist helps organize your important details. Have your Social Security Application Worksheet prepared to help fill out your application for Social Security benefits.
When to use a Social Security Application Worksheet:
- You're applying for retirement benefits.
- You're about to apply for disability benefits.
Sample Social Security Application Worksheet
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SOCIAL SECURITY APPLICATION WORKSHEET
Describe the type of injury or illness:
Describe how the injury or illness prevents you from working:
Have you returned to work? Yes
HOSPITAL(S)
| Hospital or Clinic: |
| Treating Physician: |
Date you stopped working:
DISABILITY BENEFITS CHECKLIST
Depending on your situation, you may need some or all of the following information when making an application to obtain social security disability benefits. This checklist will assist you in preparing to apply for social security disability benefits.
- Your social security number;
- Your birth certificate or other evidence of your date of birth;
- Your military discharge papers, if you were in the military;
| - Your spouse's birth certificate and social security number if he/she is applying for benefits; |
| - Your children's birth certificates and social security numbers if they are applying for benefits; |
- Your checking or savings account information, so your benefits can be directly deposited;
- Names, addresses, and phone numbers of doctors, hospitals, clinics, and institutions that have treated you and dates of the treatment(s);
- Names of all medications you are taking;
- Medical records from your doctors, therapists, hospitals, clinics, and caseworkers;
- Laboratory and test results;
| - A summary of where you worked over the past 15 years and the kind of work you did, including names and addresses of current and past employers; |
| - A copy of your W-2 form (Wage and Tax Statement), or if you are self-employed, your Schedule SE from your federal tax return for the past year; |
- Dates of prior marriages if your spouse is applying.
