Can I get help with form SSA ? What is form SSA? Search Results related to ssa form pdf on Search Engine. Disability Report- Adult ssa. If the applicant is currently working, provide information about any changes in his or her work activity. For example, an applicant may be able to work 10 hours per week, but his employer allows extra breaks and a flexible schedule when the applicant experiences anxiety.
Information about this employer accommodation is not available to SSA in an earnings record, so it is important to provide details on the SSA Provide information in this section about the highest grade the applicant completed and details about special education or specialized training.
Information about special education can be valuable to the disability determination. Specialized training can include: military training, trade and vocational schools, and Job Corps. Provide details about this training, even if the program was started but not completed. List the jobs up to 5 that the applicant has had in the 15 years before he or she became unable to work. List the most recent job first and do not exclude jobs from the list just because earnings are minimal. If the applicant did not work at all in the 15 years before he or she became unable to work, check the box and go to Section 7 — Medicines.
Job title: Enter the type of job performed, not the name of the employer. If the applicant does not remember their job title, add a generic title that describes the tasks performed.
Type of business: Enter the name or type of business. Hours per day, days per week, and rate of pay. If the applicant had only one job in the last 15 years, answer the rest of the questions in Section 6.
If the applicant had more than one job in the last 15 years before he or she became unable to work, do not answer the rest of the questions in Section 6 and go to Section 7.
How It Works. Mercedes rating. How to fill out and sign calculadora online? Fill in the requested fields which are yellow-colored. Hit the arrow with the inscription Next to move on from one field to another.
Use the e-autograph solution to e-sign the form. Insert the date. Check the whole e-document to be sure that you have not skipped anything. Do not count sick. We may contact you for more information.
Has your condition s caused you to make changes in your work activity? When did your condition s first start bothering you? Do not. Check the highest grade of school completed. Did you attend special education classes? Dates attended special education classes: from.
Have you completed any type of specialized job training, trade, or vocational school? If you need to list other education or training use Section 11 - Remarks on the last page. List the jobs up to 5 that you have had in the 15 years before you became unable to work. List your most recent job first.
Check here and go to Section 7 on page 5 if you did not work at all in the 15 years before you became. Page 4. I had only one job in the last 15 years before I became unable to work. Answer the questions below. I had more than one job in the last 15 years before I became unable to work. Do not answer the. Do not complete this page if you had more than one job in the last 15 years before you became unable to work.
Describe this job. What did you do all day? If you need more space, use Section 11 - Remarks on the last page. In this job, did you:. Do any writing, complete reports, or perform any duties like this? In this job, how many total hours each day did you do each of the tasks listed:. Task Hours Task. Kneel Bend legs to rest on knees.
Lifting and carrying Explain in the box below, what you lifted, how far you carried it, and how often you did.
Check heaviest weight lifted:. Less than 10 lbs. Did you supervise other people in this job? Yes Complete items below. No if No, go to 6. What part of your time did you spend supervising people? Were you a lead worker? Page 5. Are you taking any medicines prescription or non-prescription? Yes Give the information requested below. You may need to look at your medicine containers. No Go to Section 8-Medical Treatment.
If you need to list other medicines, go to Section 11 - Remarks on the last page. Have you seen a doctor or other health care professional or received treatment at a hospital or clinic, or do you have a.
0コメント