SOAR Checklist for Initial Claims (Complete checklist and place on top of application packet before submitting to SSA.) __________________________ Date: Claimant’s Name: ________________________________ SSN: _________________ Caseworker’s Name: ______________________________ Phone #: _______________ Paper Forms SSA-8000: Application for Supplemental Security Income (SSI) SSA-827: Authorization to Disclose Information to SSA SSA-1696: Appointment of Representative If applicable: SSA-3373 Function Report (Only needed if a medical summary report according to the SOAR training is submitted). NOT SSA-4814 Medical Report on Adult with Allegation of Human Immunodeficiency Virus (HIV) Infection On-line Forms Internet Disability Report Submitted on: ___________________ – SSA-16: Application for Social Security Disability Insurance (SSDI) Submitted – on:___________________ Medical Summary Report Medical Records
SOAR Checklist for Initial Claims (Complete checklist and place on top of application packet before submitting to SSA.) Date: __________________________ Claimant’s Name: ________________________________ SSN: _________________ Caseworker’s Name: ______________________________ Phone #: _______________ Paper Forms SSA-8000: Application for Supplemental Security Income (SSI) SSA-827: Authorization to Disclose Information to SSA SSA-1696: Appointment of Representative If applicable: SSA-3373 Function Report (Only needed if a medical summary report according to the SOAR training is NOT submitted). SSA-4814 Medical Report on Adult with Allegation of Human Immunodeficiency Virus (HIV) Infection On-line Forms Internet Disability Report – Submitted on: ___________________ SSA-16: Application for Social Security Disability Insurance (SSDI) – Submitted on:___________________ Medical Summary Report Medical Records
SOAR_Checklist_Initial_Claims.docx