Proof of Income (Last Year's W-2 Form , IRS 1040 or Schedules C and SE)
Date You Became Unable to Work
Names, Addresses, and Phone Numbers for All Previous Doctors, Hospitals, and Clinics
Record of Current Treatments
List of Current Medications
Names & Dates of Any Previous Medical Tests & Who Ordered Them
List of Jobs & Dates Employed (up to 5) within the Last 15 Years Prior to Inability to Work
Military Service Discharge Information (Form DD 214) for All Periods of Active Duty (if applicable)
List of Numbers & Insurance Company Information for Any Public Disability Benefits or Workers' Compensation Claims Filed
Dates of Marriages and Divorces (if applicable)
Identification Information for Any Minor Children & Spouses (if applicable)
Checking or Savings Account Number & Bank 9-Digit Routing Number (for Direct Deposit)
How It Works
The Social Security and Supplemental Security Income disability programs are the largest of several Federal programs that provide assistance to people with disabilities. Social Security Disability Insurance pays benefits to you and certain members of your family if you are "insured," meaning that you worked long enough and paid Social Security taxes.
HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).