APPLY for Social Security Disability Benefits Online

Information About You:

• Your birth date, 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 and the account number

Information About Your Medical Condition:

• Name, address, and phone number of someone that SSA can contact who knows about your medical conditions
• Detailed information about your medical illnesses, injuries, or conditions:
  • Names, addresses, phone numbers, and dates of treatment for all doctors, hospitals, and clinics;
  • Names of medicines you are taking and who prescribed them; and
  • Names and dates of medical tests performed 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
• The dates of any active U.S. military service
• A list of the jobs that you held 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:
  • Be temporary or permanent in nature;
  • Include annuities and lump sum payments that you received in the past;
  • Be paid by your employer or your employer’s insurance carrier, private agencies, or Federal, State or other government or public agencies; and
  • 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.)