Medicaid and Public Health Plans - HealthPocket

Social Security Disability Insurance (SSDI)

Ways to Learn More

Speak with a licensed agent

(800) 984-8015


Application Instructions

Complete the online Application and submit it, along with copies of your sign-up checklist items, to your local Social Security office.

Sign-Up Checklist

  1. Completed Application
  2. Completed Adult Disability Report
  3. Completed Authorization to Disclose Information to the Social Security Administration
  4. Personal Identification Information
  5. Social Security Number
  6. Patient ID Number
  7. Proof of Income (Last Year's W-2 Form , IRS 1040 or Schedules C and SE)
  8. Date You Became Unable to Work
  9. Names, Addresses, and Phone Numbers for All Previous Doctors, Hospitals, and Clinics
  10. Record of Current Treatments
  11. List of Current Medications
  12. Names & Dates of Any Previous Medical Tests & Who Ordered Them
  13. List of Jobs & Dates Employed (up to 5) within the Last 15 Years Prior to Inability to Work
  14. Military Service Discharge Information (Form DD 214) for All Periods of Active Duty (if applicable)
  15. List of Numbers & Insurance Company Information for Any Public Disability Benefits or Workers' Compensation Claims Filed
  16. Dates of Marriages and Divorces (if applicable)
  17. Identification Information for Any Minor Children & Spouses (if applicable)
  18. Checking or Savings Account Number & Bank 9-Digit Routing Number (for Direct Deposit)

Plan Summary

23464 - Chesapeake City, VA

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.

  • 800-772-1213
  • From $0 & Up
  • Website Link

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