Form Ssa-16-Bk - Application For Disability Insurance Benefits - Social Security Administration Page 7

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RECEIPT FOR YOUR CLAIM FOR SOCIAL SECURITY DISABILITY INSURANCE BENEFITS
PERSON TO CONTACT ABOUT YOUR CLAIM
SSA OFFICE
DATE CLAIM RECEIVED
TELEPHONE NUMBER (INCLUDE AREA CODE)
some other change that may affect your claim, you — or
Your application for Social Security disability benefits has
someone for you — should report the change. The changes to
been received and will be processed as quickly as possible.
be reported are listed below.
You should hear from us within
days after you have
Always give us your claim number when writing or telephoning
given us all the information we requested. Some claims may
about your claim.
take longer if additional information is needed.
If you have any questions about your claim, we will be glad to
In the meantime, if you change your address, or if there is
help you.
CLAIMANT
SOCIAL SECURITY CLAIM NUMBER
CHANGES TO BE REPORTED AND HOW TO REPORT
FAILURE TO REPORT MAY RESULT IN OVERPAYMENTS THAT MUST BE REPAID
You change your mailing address for checks or
Change of Marital Status—Marriage, divorce, annulment
residence. To avoid delay in receipt of checks you
of marriage. You must report marriage even if you
should ALSO file a regular change of address notice
believe that an exception applies.
with your post office.
You return to work (as an employee or self-employed)
Your citizenship or immigration status changes.
regardless of amount of earnings.
You go outside the U.S.A. for 30 consecutive days or
Your condition improves.
Your condition improves.
longer.
Any beneficiary dies or becomes unable to handle
benefits.
You are under age 65 and you apply for or begin to receive
workers' compensation (including black lung benefits) or
another public disability benefit, or the amount of your
Custody Change—Report if a person for whom you are
lity benefit
filing or who is in your care dies, leaves your care or
present workers' compensation or public disabi
custody, or changes address.
changes or stops, or you receive a lump-sum settlement
You are confined to jail, prison, penal institution or
Text
correctional facility for conviction of a crime or you are
HOW TO REPORT
confined to a public institution by court order in
connection with a crime.
You can make your reports by telephone, mail, or in
You become entitled to a pension or annuity based on
If you are awarded benefits, and one or more of
person, whichever you prefer.
your employment after 1956 not covered by Social
thhange(s) should be reported by:
Security, or if such pension or annuity stops.
If you are awarded benefits, and one or more of the above
change(s) occur, you should report by:
Your stepchild is entitled to benefits on your record
and you and the stepchild's parent divorce. Stepchild
Calling us TOLL FREE at 1-800-772-1213.
benefits are not payable beginning with the month
 If you are deaf or hearing impaired, calling us TOLL
after the month the divorce becomes final.
FREE at TTY 1-800-325-0778; or
You have an unsatisfied warrant for your arrest for a
 Calling, visiting or writing your local Social Security
crime or attempted crime that is a felony (or, in
office at the phone number and address above.
jurisdictions that do not define crimes as felonies, a
crime that is punishable by death or imprisonment for
For general information about Social Security, visit our
a term exceeding 1 year).
web site at
You have an unsatisfied warrant for a violation of
probation or parole under Federal or State law.
Form SSA-16-BK (05-2006)
EF (12-2008)
Page 7

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