Ticket to Work EN Agreement · SSA / Maximus
Assignment of Ticket to Work to an Employment Network or State Vocational Rehabilitation agency. Provides CDR protection while participating in employment services.
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Call the Ticket to Work helpline
Call 1-866-968-7842 (TTY 1-866-833-2967) to enroll by phone.
Enrollment is typically immediate once you select an Employment Network (EN) or Vocational Rehabilitation provider.
Your chosen Employment Network will develop an Individual Work Plan (IWP) with you. While your ticket is in use and you are making timely progress, SSA will not conduct a medical Continuing Disability Review.
SSA-16-BK · SSA
Application for Social Security Disability Insurance Benefits. Requires detailed work history, earnings record, and medical condition documentation.
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.
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.
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.
SSA-3373-BK · SSA
10-page functional assessment covering ADL capacity, daily routines, social functioning, cognitive abilities, and physical limitations.
SSA-827 · SSA
Authorization allowing SSA to collect medical and other information from providers, hospitals, and other sources for disability determination.
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