DI 10105: Disability Insurance Benefits (DIB) and Freeze
BASIC (06-06)
The following chart provides a list of the most commonly required forms and proofs needed for most disability claims. This chart is not all-inclusive.
Subject |
When Required |
---|---|
Application |
Always for Disability Insurance Benefit (DIB) and/or freeze |
Disability |
Required for entitlement. Not necessary if claim is disallowed on other grounds.(See DI 11005.001 and DI 11010.035) |
Disability Insured Status |
Required for entitlement. Not necessary if the claim is disallowed on other grounds. (See DI 10105.145 and DI 11010.035) |
SSA-3368-BK ( Disability Report – Adult) or electronic equivalent |
If disability is developed.
NOTE: Under the jurisdiction of Collateral Estoppel the SSA-3368-BK does not need to be prepared for cases if a full disability determination is being adopted (e.g., partial award not involved) and a Disability Determination Service (DDS) determination is not needed. (See DI 11011.001B.) |
SSA-827 (Authorization For Source To Release Information To The Social Security Administration) |
Completed for all disability claims and in non-disability claims in which capability is an issue. |
Proof-of-Age |
|
SSA-3369 (Work History Report) or electronic equivalent |
When the conditions in DI 11005.025B. are met. |
Selection of Representative Payee |
If the NH is incapable of handling his/her funds (See GN 00502.001). |
SSA-21 (Supplement to Claim of Person Outside the United States) |
If claimant lives outside the U.S. or intends to leave the U.S. (See GN 00205.180). |
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