This is an archival or historical document. It may not reflect current policies or procedures.

Thank you for completing the first part of the online disability process.

We now ask that you complete the Adult Disability Report.

This report asks you about your medical condition, your doctors, and how your condition affects your ability to work.

I recommend that you print the disability checklist to help answer the detailed questions in this section.

To help protect your privacy, we will ask you enter the last four digits of your Social Security number before you begin the report.

As you proceed, you will receive a re-entry number.

Please print or write this number down.

If you need to stop working on the report before you're ready to submit the report, you will need this number to return to your report.

Prior to finishing the report, we also ask that you complete the authorization to disclose information form.

You can do this electronically, or print and mail it to your local Social Security office.

We need this form to obtain your medical records.

Thank you for providing this important information.

To continue, please select the Adult Disability Report.