The Application Checklist

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S and L Application Checklist (pdf)
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Read How To Apply For Social Security Disability

Application Checklist

This is information you will need not only for the application, but also to bring to your Spector and Lenz appointment.

1. Date of Birth and Place of Birth
   • Note if you were born outside the U.S.
2. Medications
   • Bring a list of your current medications, including dose and frequency
   • List major side effects of each medication
3. Doctors
   • List of your doctors’ names, phone numbers, hospitals
     Anyone else you have seen for medical care: physical therapy, psychologist, chiropractor, etc.
4. Conditions
   • Draw up a complete list of conditions including stroke, heart attack, allergies
5. Work
   • The exact date you last worked (not fired, not quit, not after FMLA)
     Last date of work
6. Medicaid Number
   • If applicable, start and end dates
7. Workers compensation
   • List for each claim
   • What claim was filed for
   • When filed
   • When settled
   • Amount of settlement
8. Current health insurance:
   • Plan name and your plan ID number (bring card)
   • Start and end dates with current employer
   • Start and end dates for your group health insurance plan
9. Marriage and divorce status
   • Name of current spouse, date of birth, and Social Security number
   • Name of prior spouse
   • Beginning and ending dates of marriage(s)
   • Place of marriage(s) (city, state)
10. Names and DOB of children who are:
    • Under age 18 and unmarried
    • Aged 18–19 and attending high school full time
    • Who became disabled before age 22
11. Military Service
    • Type of duty and branch
    • Service period dates
12. Employer details
    • For current year and prior two years (not self-employment)
    • Employer name
    • Start and end dates
    • Social Security statement (online at www. socialsecurity .gov/ myaccount).
13. Self-employment details
    • For current year and prior two years
    • Business type
    • Total net income from self-employment
14. Direct deposit
    • Account type and number
    • Bank routing number

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S and L Application Checklist (pdf)
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