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. Print and review the Adult
Disability Checklist.

Checklist for Online Adult Disability Application

This checklist will help you gather the information you may need to complete the online adult Disability application process. We
recommend you print this page to use while you gather your information. We hope you find our online application easy and convenient.

Birth and Citizenship Information

If you were born outside the United States or its territories:
Name of your birth country at the time of your birth (it may have a different name now)

Permanent Resident Card number (if you are not a U.S. Citizen)

Marriage and Divorce

Name of current spouse and prior spouse (if the marriage lasted more than 10 years or ended in death)

Spouse(s) date of birth and SSN (optional)

Beginning and ending dates of marriage(s)

Place of marriage(s) (city, state or country, if married outside the U.S.)

Names and Birth Dates of Children Who

Became disabled prior to age 22, or

Are under age 18 and are unmarried, or

Are aged 18 to 19 and still attending secondary school full time

U.S. Military Service

Type of duty and branch

Service period dates

Employer Details for Current Year and Prior 2 Years (not self-employment)

View your Social Security Statement online at: www.ssa.gov/myaccount

Employer name

Employment start and end dates

Total earnings (wages, tips, etc.)

Self-Employment Details for Current Year and Prior 2 Years

View your Social Security Statement online at: www.ssa.gov/myaccount

Business type and total net income

Direct Deposit

Domestic bank (USA)
Account type and number
Bank routing number

International Bank (Non-USA)
International Direct Deposit (IDD) bank country
Bank name, bank code, and currency
Account type and number
Branch/transit number

Name, address and phone number of someone we can contact who knows about your medical condition(s) and can help you with your claim

List of your medical conditions
Information about Doctors, Healthcare Professionals, Hospitals and Clinics

Names, addresses, phone numbers, patient ID numbers, and dates of examinations and treatments

Names and dates of medical tests you have had and who sent you for them

Names of medications (prescriptions and non-prescriptions), reason for medication and who prescribed them

Information about other medical records that may be available from vocational rehabilitation services, workers compensation, public welfare, prison or jail, an attorney or lawyer, or another place
Job History

Date your medical condition began to affect your ability to work

Type of jobs (up to 5) that you had in the 15 years before you became unable to work because of your medical condition

Dates you worked at those jobs, if available

Type of duties you did on the longest job you had

Education and Training

Highest grade in school completed and date you completed it

Name of special job training, trade school or vocational school and date completed

Special education school name, city and state, and date completed

We may contact you for additional information after you submit your online 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:
o Names, addresses, phone numbers, patient ID numbers and dates of treatment for all doctors, hospitals and clinics;
o Names of medicines you are taking and who prescribed them; and
o 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:
o Be temporary or permanent in nature;
o Include annuities and lump sum payments that you received in the past;
o Be paid by your employer or your employer’s insurance carrier, private agencies, or Federal, State or other government or
public agencies; and
o 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.)