Disability Resources for People in Maryland, Virginia & Washington, DC

The Adult Disability Report is one of the first forms you see when you’re applying for Social Security Disability benefits. This is where you explain the health problems that are keeping you from work.

You’ll include this information on the form:

• The date when your medical problem began
• The symptoms you are experiencing
• Your medical history
• The medical treatment you have received
• The doctors who have treated you
• The medical facilities where you have gone for treatment
• An explanation of how your health condition prevents you from working
• An explanation of why you cannot perform past jobs or other jobs you otherwise would be qualified to hold

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The Social Security Administration (SSA) uses this form to determine if workers’ comp or other benefits will offset some of your Social Security Disability benefits.

You’ll include this information on the form:

• The type of workers’ comp or public disability  benefits you’re receiving
• The employer where you were injured
• Your employer’s insurance carrier
• The date you were injured
• The period you’ve been receiving workers’ comp
• The amount of workers’ comp you’ve received
• Your workers’ comp claim number
• The status of your claim if you haven’t started receiving workers’ comp

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On this form, you’ll give details of your past jobs.

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Filling out this form is the first step in appealing a denial of Social Security Disability benefits.

You must start your appeal within 60 days of receiving notice that your benefits were denied.

Don’t leave any details blank on this form.

You’ll include this information:

• Details of your medical condition
• Information about your medical records
• Details about doctors or other health care professionals you’ve seen
• Details about hospitals and clinics where you have gone for treatment
• Information about medications you have taken
• Details about medical tests you have received
• An update of your work status
• An update about your daily activities

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This form is part of appealing a denial of Social Security Disability benefits. You use it to provide details of the medical help you have received for the health problems that force you out of work.

You’ll include this information on the form: :

• Every doctor you have seen
• Dates when you received treatment
• If you were hospitalized because of your disability, name and address of the hospital
• Reasons you were hospitalized
• Details of treatment you received in the hospital

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This form is part of appealing a denial of Social Security Disability benefits. You use it to provide details of the medications you’re taking for the health problems that leave you unable to work, and any other health conditions.

You’ll include this information on the form:

• Each medication and dosage
• Date each medication was first prescribed
• The reason you’re taking each medication
• The doctor who prescribed each medication
• Any non-prescription medications you take and the reasons you’re taking them

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When you’re appealing a denial of Social Security Disability benefits, this form will ask you to update what has happened with your medical and work situation since you first applied for benefits.

This is an opportunity to describe your condition, and you should take advantage of the chance to explain your case.

You’ll include this information on the form:

• Has your health changed for better or worse?
• How have your daily activities changed?
• What new medical treatment have you received?

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When you’re appealing a denial of Social Security Disability benefits, you use this form to explain your past jobs.

Social Security uses the information to decide whether your disability prevents you from doing your previous work, or if you could adjust to a different kind of work.

You’ll include this information on the form:

• Dates of employment
• Names and locations of employers
• Duties you performed in each job

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