Disability Starter Kits

Checklist - Adult Disability Interview

You should have as much of the following information as possible ready for your interview. Keep your appointment, even if you do not have all of the information. We will help you get any missing information.

Check off the items below as you get them together for your interview.

Medical Information

		Names, addresses and phone numbers of all doctors, hospitals and clinics.
		Patient ID number(s)
		Dates seen
		Names(s) of medicine(s) you are taking
		Medical records in your possession

	An original or certified copy of your birth certificate. If you were born in another country, we need proof of U.S. citizenship or legal residency.
	If you were in the military service, the original or a certified copy of your military discharge papers (Form DD 214) for all periods of active duty.
	If you worked, your W-2 Form from last year, or if you were self-employed, your federal tax return (IRS 1040 and Schedules C and SE).
	Workers' compensation information, including date of injury, claim number and proof of payment amounts.
	Social Security Number(s) of your spouse and minor children.
	Your checking or savings account number if you have one.
	Name, address and phone number of a person who we can contact if we are unable to get in touch with you.
	Kinds of jobs and dates you worked in the 15 years before you became unable to work.