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Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
Answers to your practical questions such as how to travel safely despite your health condition, how to avoid getting infected by a pet, and what to say or not say to an insurance company.

Content Overview

SSI: The Forms Used When Applying For



There are several forms that Social Security uses to start the SSI application process. Social Security usually sends you the forms known as Disability Report and Work History Report at the time you make the appointment so that you can bring them in completed. There are offices that wait and complete the forms during the interview.

While you will want to use the forms Social Security provides rather than complete the version you find here, the forms you find here will provide a guide to assembling the information you need to accumulate.

Before completing SSI forms, it is suggested that you read: Tips When Completing Questionnaires Concerning Your Medical Condition.

The Social Security interviewer will help complete any part of the forms that you don't complete. However, interviewers have only a limited amount of time and no one is as interested as you are in seeing that you get approved for benefits. It is recommended that you answer every question on the forms before going to the interview.

The forms are:

(Preliminary) Application for Supplemental Security Income, SSA-8001-F5 (7-90).

This form is an abbreviated form of the SSA-8000-BK (below). It is often used to open a disability claim and make an initial determination of financial eligibility in order to start the medical review.

Application for Supplemental Security Income, SSA-8000-BK (5-90).

The form asks for many details about your financial situation. If you at least start the process by supplying form 8001, you can be working on the documentation for the 8000 while the medical review is taking place. In many Social Security offices the form 8000 is only completed after the medical review is completed and you are declared disabled. Once you're declared to be disabled, then Social Security will determine if you qualify for SSI on the basis of your lack of income and resources.

For children filing for SSI benefits, in addition to completing a SSA-8000-BK on the child's financial and other non-medical information, the parents must complete SSA-8010-U5 concerning their own income and resources, some of which may be "deemed" to belong to the child. (If you obtain a copy of the form, please forward it to Survivorship A to Z so share it with other people in a situation similar to yours.)

Disability Report

Adults use form SSA-3368-BK (12-98), Adult Disability Report

This form is used when applying for all Social Security claims for disability benefits. This form is usually sent to you at the time you make an appointment to apply for benefits, whether the appointment is to be in-person or by telephone. Before completing the form, it is helpful to understand what Social Security is looking for with respect to each question to help you frame your answer appropriately. To learn more, see: Form SSA-3368-BK

Children under age 22 use Disability Report - Child, SSA-3820-BK (12-98) Child Disability Report. Children must also complete a non-medical form SSA Form 3881-BK Child Claiming SSI Benefits.

Work History Report, SSA-3369-BK (7-98)

Disability Report - Field Office SSA-3367-F4 (7-99) Presumptive Disability App.

This form is used to apply for Presumptive Disability.

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