Adult Disability Interview Checklist Template
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1Checklist – Adult Disability Interview
We encourage you to begin the application process online.
Visit to get started!
Use this Checklist to get ready for your appointment or when filing online. We need your
personal and income information to complete the interview to determine if you are eligible
for disability benefits. Keep your appointment even if you do not have all of the information.
We will help you get any missing information.
;
Check off the applicable items below as you get them together for your interview.
‰ Medical records already in your possession. (We will help you get the
rest of your medical records. Please bring whatever medical records you
have to the interview).
‰ Workers’ compensation information, including the settlement
agreement, date of injury, claim number, and proof of other disability
awarded payment amounts.
‰ Names and dates of birth of your minor children and your spouse.
‰ Dates of marriages and divorces.
‰ Checking or savings account number, including the bank’s 9-digit
routing number, if you want Direct Deposit for your benefit checks.
‰ Name, address, and phone number of a person we can contact if we are
unable to get in touch with you.
‰ If a medical release Form SSA-827 (Authorization to Disclose Information
to the Social Security Administration) was included with this package,
please complete (sign and date with witness signature) and return it
as directed.
‰ If unable to file online, complete the “Medical and Job Worksheet –
Adult” and bring to your interview.
Bring the Checklist items and information to your appointment or have
them with you if your appointment is by telephone.
Do not delay filing your application, even if you do not have all
of the information.
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