Form Ssa-16-F6 - Application For Disability Insurance Benefits
ADVERTISEMENT
1
2)25 <285 ,1)250$7,21
$Q DJHQF\ LQ \RXU 6WDWH WKDW ZRUNV ZLWK XV LQ DGPLQLVWHULQJ WKH
6RFLDO 6HFXULW\ GLVDELOLW\ SURJUDP LV UHVSRQVLEOH IRU PDNLQJ WKH
GLVDELOLW\ GHFLVLRQ RQ \RXU FODLP ,Q VRPH FDVHV LW LV QHFHVVDU\ IRU
WKHP WR JHW DGGLWLRQDO LQIRUPDWLRQ DERXW \RXU FRQGLWLRQ RU WR DUUDQJH
IRU \RX WR KDYH D PHGLFDO H[DPLQDWLRQ DW *RYHUQPHQW H[SHQVH
&ROOHFWLRQ DQG 8VH RI ,QIRUPDWLRQ )URP <RXU $SSOLFDWLRQ
3ULYDF\ $FW 1RWLFH3DSHUZRUN $FW 1RWLFH
7KH 6RFLDO 6HFXULW\ $GPLQLVWUDWLRQ LV DXWKRUL]HG WR FROOHFW WKH
$OWKRXJK WKH LQIRUPDWLRQ \RX IXUQLVK RQ WKLV IRUP LV DOPRVW
LQIRUPDWLRQ RQ WKLV IRUP XQGHU VHFWLRQV E F
QHYHU XVHG IRU DQ\ RWKHU SXUSRVH WKDQ VWDWHG LQ WKH
D DQG RI WKH 6RFLDO 6HFXULW\ $FW DV DPHQGHG
IRUHJRLQJ WKHUH LV D SRVVLELOLW\ WKDW IRU WKH DGPLQLVWUDWLRQ RI
86& E F D DQG LL :KLOH LW LV
WKH 6RFLDO 6HFXULW\ SURJUDPV RU IRU WKH DGPLQLVWUDWLRQ RI
92/817$5< H[FHSW LQ WKH FLUFXPVWDQFHV H[SODLQHG EHORZ
SURJUDPV UHTXLULQJ FRRUGLQDWLRQ ZLWK WKH 6RFLDO 6HFXULW\
IRU \RX WR IXUQLVK WKH LQIRUPDWLRQ RQ WKLV IRUP WR 6RFLDO
$GPLQLVWUDWLRQ LQIRUPDWLRQ PD\ EH GLVFORVHG WR DQRWKHU
6HFXULW\ QR EHQHILWV PD\ EH SDLG XQOHVV DQ DSSOLFDWLRQ KDV
SHUVRQ RU WR DQRWKHU JRYHUQPHQWDO DJHQF\ DV IROORZV WR
EHHQ UHFHLYHG E\ D 6RFLDO 6HFXULW\ RIILFH <RXU UHVSRQVH LV
HQDEOH D WKLUG SDUW\ RU DQ DJHQF\ WR DVVLVW 6RFLDO 6HFXULW\ LQ
PDQGDWRU\ ZKHUH WKH UHIXVDO WR GLVFORVH FHUWDLQ LQIRUPDWLRQ
HVWDEOLVKLQJ
ULJKWV
WR
6RFLDO
6HFXULW\
EHQHILWV
DQGRU
DIIHFWLQJ \RXU ULJKW WR SD\PHQW ZRXOG UHIOHFW D IUDXGXOHQW
FRYHUDJH WR FRPSO\ ZLWK )HGHUDO ODZV UHTXLULQJ WKH
LQWHQW WR VHFXUH EHQHILWV QRW DXWKRUL]HG E\ WKH 6RFLDO 6HFXULW\
UHOHDVH RI LQIRUPDWLRQ IURP 6RFLDO 6HFXULW\ UHFRUGV HJ WR
$FW 7KH LQIRUPDWLRQ RQ WKLV IRUP LV QHHGHG WR HQDEOH 6RFLDO
WKH
*HQHUDO
$FFRXQWLQJ
2IILFH
DQG
WKH
9HWHUDQV
6HFXULW\ WR GHWHUPLQH LI \RX DQG \RXU GHSHQGHQWV DUH HQWLWOHG
$GPLQLVWUDWLRQ DQG WR IDFLOLWDWH VWDWLVWLFDO UHVHDUFK DQG
WR LQVXUDQFH FRYHUDJH DQGRU PRQWKO\ EHQHILWV )DLOXUH WR
DXGLW DFWLYLWLHV QHFHVVDU\ WR DVVXUH WKH LQWHJULW\ DQG
SURYLGH DOO RU SDUW RI WKLV LQIRUPDWLRQ FRXOG SUHYHQW DQ
LPSURYHPHQW RI WKH 6RFLDO 6HFXULW\ SURJUDPV HJ WR WKH
DFFXUDWH DQG WLPHO\ GHFLVLRQ RQ \RXU FODLP RU \RXU
%XUHDX RI WKH &HQVXV DQG SULYDWH FRQFHUQV XQGHU FRQWUDFW WR
GHSHQGHQW
V FODLP DQG FRXOG UHVXOW LQ WKH ORVV RI VRPH
6RFLDO 6HFXULW\
EHQHILWV RU LQVXUDQFH FRYHUDJH
:H PD\ DOVR XVH WKH LQIRUPDWLRQ \RX JLYH XV ZKHQ ZH PDWFK UHFRUGV E\ FRPSXWHU 0DWFKLQJ SURJUDPV FRPSDUH RXU UHFRUGV
ZLWK WKRVH RI RWKHU )HGHUDO 6WDWH RU ORFDO JRYHUQPHQW DJHQFLHV 0DQ\ DJHQFLHV PD\ XVH PDWFKLQJ SURJUDPV WR ILQG RU SURYH
WKDW D SHUVRQ TXDOLILHV IRU EHQHILWV SDLG E\ WKH )HGHUDO JRYHUQPHQW 7KH ODZ DOORZV XV WR GR WKLV HYHQ LI \RX GR QRW DJUHH WR LW
([SODQDWLRQV DERXW WKHVH DQG RWKHU UHDVRQV ZK\ LQIRUPDWLRQ \RX SURYLGH XV PD\ EH XVHG RU JLYHQ RXW DUH DYDLODEOH LQ 6RFLDO
6HFXULW\ RIILFHV ,I \RX ZDQW WR OHDUQ PRUH DERXW WKLV FRQWDFW DQ\ 6RFLDO 6HFXULW\ RIILFH
3$3(5:25. 5('8&7,21 $&7 127,&( $1' 7,0( ,7 7$.(6 67$7(0(17
7KH 3DSHUZRUN 5HGXFWLRQ $FW RI UHTXLUHV XV WR QRWLI\ \RX WKDW WKLV LQIRUPDWLRQ FROOHFWLRQ LV LQ DFFRUGDQFH ZLWK WKH
FOHDUDQFH UHTXLUHPHQWV RI VHFWLRQ RI WKH 3DSHUZRUN 5HGXFWLRQ $FW RI :H PD\ QRW FRQGXFW RU VSRQVRU DQG \RX DUH
QRW UHTXLUHG WR UHVSRQG WR D FROOHFWLRQ RI LQIRUPDWLRQ XQOHVV LW GLVSOD\V D YDOLG 20% FRQWURO QXPEHU :H HVWLPDWH WKDW LW ZLOO
WDNH \RX DERXW PLQXWHV WR FRPSOHWH WKLV IRUP 7KLV LQFOXGHV WKH WLPH LW ZLOO WDNH WR UHDG WKH LQVWUXFWLRQV JDWKHU WKH
QHFHVVDU\ IDFWV DQG ILOO RXW WKH IRUP
A‚…€ÃTT6 %A%Ã( (((
@AÃ#!
QhtrÃ$
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal