[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-306810-105":53,"doc-detail-306810-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","application-for-disability-insurance-benefits-application-form","APPLICATION FOR DISABILITY INSURANCE BENEFITS - Application form","","Application for Disability Insurance Benefits for a period of disability and/or related insurance benefits under Title II and Title XVIII of the Social Security Act. The form requests identifying information, Social Security numbers, birth details, language preference, citizenship/immigration status, prior names, prior applications, and the date the claimant became unable to work. 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It also requests any preferred language and whether other names or other Social Security numbers were used.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"How does the form determine eligibility related to disability and prior benefit filings?",{"text":114,"@type":110},"It collects the date the applicant became unable to work due to illness, injuries, or conditions. 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It also includes an agreement to promptly notify the Social Security Administration if such a pension/annuity begins or stops.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},306810,1790210801,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":136,"language":137,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":138,"faqs":139,"seo_title":140,"seo_description":61,"update_tm":141,"read_time":76},1374391974585,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","TOE 120/145  \n(Do not write in this space)  \n# APPLICATION FOR DISABILITY INSURANCE BENEFITS\n\nI apply for a period of disability and/or all insurance benefits for which I ameligible under Title Iland Part A of Title XVIII of the Social Security Act,aspresently amended.  \nFIRST NAME,MIDDLE INITIAL,LAST NAME  \n1.  \nPRINT your name  \n2.  \nEnter your Social Security Number  \n3.  \n□Female  \nCheck(X)whether you are  \nMale  \n4.  \nIf this claim is awarded,do you want a password to use SSA's  \n□Yes  \n□No  \nInternet/phone service?  \nAnswer question 5 if English is not your preferred language.Otherwise,go to item 6.  \n5.  \nEnter the language you prefer to:Speak  \nWrite  \nMONTH,DAY,YEAR  \n6.  \n(a)Enter your date of birth ——  \n(b)Enter name of State or foreign country where you were born.—  \n(c)Was a public record of your birth made before you were age 5?  \n□Yes  \n□No  \nUnknown  \n(d)Was a religious record of your birth made before you were age 5?  \n□Yes  \n□No  \nUnknown  \n□  \n7.  \nNo  \nYes  \n(a)Are you a U.S.citizen?一  \nGo to item(b)  \nGo to item 8  \nYes  \n□No  \n(b)Are you an alien lawfully present in the U.S.?  \nGo to item 8  \nGo to item (c)  \n(c)When were you lawfully admitted to the U.S.?  \n(a)Enter your name at birth if different from item(1)  \n8.  \n(b)Have you used any other names?  一  \n□Yes  \n□No  \nGo to (c)  \nGo to item 9  \n(c)Other name(s)used.  \n(a)Have you used any other Social Security number(s)?  \n9.  \n□ Yes  \nGo o item 10  \nGo to(b)  \n(b)Enter Social Security number(s)used.———  \n——__/__/———  \n10.  \nEnter the date you became unable to work because of your illness,injuries,  \nor conditions.  \n11.  \n(a)Have you (or has someone on your behalf)ever filed an application for  \nYes       No□Unknown  \nSocial Security benefits,a period of disability under Social Security,  \n(If \"Yes,\"answer(If\"No,\"or \"Unknown,\"  \nSupplemental Security Income,or hospital or medical insurance under  \n(b)and (c).)  \ngo to item 12.)  \nMedicare?  \n(b)Enter name of person on whose  \nSocial Security record you filed  \nthe other application.-  \n(c)Enter Social Security Number of person named in (b).  \n——__/__/_—-  \nIf unknown,check this block.口  \nForm SSA-16-BK(12-2010)EF(12-2010)  \nPage 1  \nDestroy prior editions  \n\n| 12.   | (a)Were you in the active military or naval service(including Reserve or National  \u003Cbr>Guard active duty or active duty for training)after September 7,1939 and  \u003Cbr>before 1968?   |  | □  \u003Cbr>Yes  \u003Cbr>No  \u003Cbr>(If \"No,\"go to item  \u003Cbr>(If \"Yes,\"answer  \u003Cbr>13.)  \u003Cbr>(b)and (c).)   |  |  |\n| --- | --- | --- | --- | --- | --- |\n|  |  |  |  |  |  |\n|  | (b)Enter dates of service   |  | FROM:(Month,Year)   |  | TO:(Month,Year)   |\n|  | (c)Have you ever been (or will you be)eligible for a monthly benefit from a military  \u003Cbr>or civilian Federal agency?(Include Veterans Administration benefits only if you  \u003Cbr>waived military retirement pay.)   |  | No  \u003Cbr>Yes   |  |  |\n| 13.   | Have you or your spouse worked in the railroad industry for 5 years or  \u003Cbr>more?   |  | No  \u003Cbr>Yes   |  |  |\n| 14.   | (a)Do you have Social Security credits(for example,based on work or residence)  \u003Cbr>under another country's Social Security System?   |  | No  \u003Cbr>Yes  \u003Cbr>(If No,\"go to item  \u003Cbr>(If \"Yes,\"answer  \u003Cbr>15.)  \u003Cbr>(b).)   |  |  |\n|  | (b)List the country(ies):   |  |  |  |  |\n| 15.   | (a)Are you entitled to,or do you expect to become entitled to,a pension or  \u003Cbr>annuity based on your work after 1956 not covered by Social Security?   |  |  | No(If \"No,\"  \u003Cbr>Yes (lf\"Yes,\"  \u003Cbr>go on to item 16.)  \u003Cbr>answer(b)and (c).)   |  |\n|  | (b)    I became entitled,or expect to become entitled,beginning   |  |  | MONTH   | YEAR   |\n|  | (c)    I became eligible,or expect to become eligible,beginning   |  |  | MONTH   | YEAR   |\n\nI AGREE TO PROMPTLY NOTIFY the Social Security Administration if I become entitled to a pension or annuity basedon my employment not covered by Social Security,or if such pension or annuity stops.  \n\n| (a)Have you ever been married?   | ","cbCaisRtBCpwFzum","https://ap.wps.com/l/cbCaisRtBCpwFzum","pdf",145360,7,"English","# Application for Disability Insurance Benefits\n## Personal identification and eligibility\n## Birth and citizenship/immigration status\n## Disability onset date and prior benefit applications\n## Military, railroad, foreign credits, and pension details\n## Marital history and spouse information","[{\"question\":\"What information does the form request for the applicant’s identity and Social Security details?\",\"answer\":\"It asks for first name, middle initial, last name, Social Security number, and birth information including date of birth and place of birth. It also requests any preferred language and whether other names or other Social Security numbers were used.\"},{\"question\":\"How does the form determine eligibility related to disability and prior benefit filings?\",\"answer\":\"It collects the date the applicant became unable to work due to illness, injuries, or conditions. It also asks whether the applicant (or someone on their behalf) previously filed applications for Social Security, disability, Supplemental Security Income, or Medicare, with follow-up fields when applicable.\"},{\"question\":\"What additional history must be reported besides disability onset, such as military or pension information?\",\"answer\":\"The form asks about active military or naval service after specific dates, railroad industry work of 5 years or more, credits under another country’s Social Security system, and whether the applicant expects a pension or annuity not covered by Social Security. It also includes an agreement to promptly notify the Social Security Administration if such a pension/annuity begins or stops.\"}]","APPLICATION FOR DISABILITY INSURANCE BENEFITS - Application form | PDF",1789841383]