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
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Names, addresses and phone numbers of
all doctors, hospitals and clinics.
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Patient ID number(s)
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Dates seen
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Names(s)
of medicine(s) you are taking
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Medical
records in your possession
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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.
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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.
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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).
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Workers' compensation information, including
date of injury, claim number and proof of payment amounts.
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Social Security Number(s) of your spouse
and minor children.
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Your checking or savings account number
if you have one.
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Name, address and phone number of a
person who we can contact if we are unable to get in touch
with you.
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Kinds of jobs and dates you worked in
the 15 years before you became unable to work.
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The Worksheet will help you collect the information you need
for your interview.
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