You must have enough work credits (usually 20 credits in the last 10 years) to qualify for SSDI

Apply as soon as you become disabled — there is a 5-month waiting period before benefits begin

The key question is whether you can perform ANY substantial gainful activity, not just your past job

Social Security Disabilityhard

SSDI Application

SSA-16-BK · SSA

Application for Social Security Disability Insurance Benefits. Requires detailed work history, earnings record, and medical condition documentation.

Form Details

Total fields: 120
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Filled by: patient
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Where to Submit This Form

🌐

SSA.gov (recommended)

https://www.ssa.gov/disability/

Start your SSDI application online.

🏢

In person at local SSA office

https://secure.ssa.gov/ICON/main.jsp

📬

Mail to your local SSA office

https://secure.ssa.gov/ICON/main.jsp

Required Attachments

📎 Medical records from all treating providers
📎 Complete work history for the last 15 years (SSA-3369-BK)
📎 Function report describing daily limitations (SSA-3373-BK)
📎 Authorization to release medical records (SSA-827)
📎 Birth certificate or proof of age

Processing Time

3-6 months for initial decision. About 60% of initial claims are denied.

What Happens Next

SSA will request records from your providers, may schedule a consultative examination, and will make an initial determination. Check status at ssa.gov or 1-800-772-1213.

Tips for This Form

✓ You must have enough work credits (usually 20 credits in the last 10 years) to qualify for SSDI
✓ Apply as soon as you become disabled — there is a 5-month waiting period before benefits begin
✓ The key question is whether you can perform ANY substantial gainful activity, not just your past job
✓ If denied, appeal within 60 days — most claims are won at the hearing level

More Social Security Disability Forms

SSI Application

SSA-8000-BK · SSA

Application for Supplemental Security Income for aged, blind, and disabled individuals with limited income and resources. Must be completed via SSA interview.

Adult Disability Report

SSA-3368-BK · SSA

The most complex patient-facing disability form. 15 pages requiring complete medical history, all diagnoses, medications, treating providers, hospitalizations, and work history.

Work History Report

SSA-3369-BK · SSA

10-page report requiring detailed descriptions of all jobs held in the past 15 years including physical demands, tools used, supervision, and lifting requirements.

Function Report

SSA-3373-BK · SSA

10-page functional assessment covering ADL capacity, daily routines, social functioning, cognitive abilities, and physical limitations.

Authorization to Disclose Information

SSA-827 · SSA

Authorization allowing SSA to collect medical and other information from providers, hospitals, and other sources for disability determination.

Continuing Disability Review Report

SSA-454-BK · SSA

Required review for current SSDI/SSI recipients. 10-page form documenting current medical conditions, treatment changes, and functional status over the past 12 months.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the SSA or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.