Social Security Benefits Application Form

Medicare Part A Costs

One big benefit of Medicare Part A is that most people are eligible to participate without having to pay a monthly premium. If you or your spouse paid into the Medicare program via payroll withholding for at least 10 years, you generally wont have to pay for Part A coverage.

Some people who dont have 10 full years of work history will have to pay monthly premiums. Those working between 30 and 39 quarters will pay $278 per month in 2023, up $4 from 2022. Those with less than 30 quarters of eligible work history have to pay $506 per month, higher by $7 from year-earlier levels.

If you need to use your Part A coverage during the year, there are additional costs under the program. A deductible of $1,600 for 2023 applies upfront before Medicare starts to cover costs. Thats $44 higher than it was in 2022.

There are also copayments for many Part A services. After the deductible is met, Medicare provides full coverage for the first 60 days of a hospital stay. From the 61st day to the 90th, the copayment is $400 per day, up $11 from 2022. On the 91st day and beyond, you have 60 lifetime reserve days for which youll pay $800 per day in 2023, $22 higher than in 2022.

The cost structure for skilled nursing-facility stays is similar. Copayments are $0 for the first 20 days, and then from the 21st day to the 100th day, patients have to pay $200 per day. Thats up by $5.50 per day from 2022. Beyond the 100th day, Medicare no longer offers coverage.

When Should I Sign Up For Medicare

Generally, we advise people to file for Medicare benefits 3 months before age 65. Remember, Medicare benefits can begin no earlier than age 65. If you are already receiving Social Security, you will automatically be enrolled in Medicare Parts A and B without an additional application. However, because you must pay a premium for Part B coverage, you have the option of turning it down. You will receive a Medicare card about two months before age 65. If you would like to file for Medicare only, you can apply by calling 1-800-772-1213. Our representatives there can make an appointment for you at any convenient Social Security office and advise you what to bring with you. When you apply for Medicare, we often also take an application for monthly benefits. You can apply for retirement benefits online.

If you didnt sign up when you were first eligible for Medicare, you can sign up during the General Enrollment Period between January 1 and March 31 each year, unless you are eligible for a Special Enrollment Period.

The Basics About Survivors Benefits

. If you are working and paying into Social Security, some of those taxes you pay are for survivors benefits. Your spouse, children, and parents could be eligible for benefits based on your earnings.

. You and your family could be eligible for benefits based on the earnings of a worker who died. The deceased person must have worked long enough to qualify for benefits.

For more information, please read .

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How To Apply Apply For Ssdi Or Ssi Benefits

Online+

If you think you may be eligible for payments, you can apply for disability benefits online with the Social Security Administration.

If you think you may be eligible for payments, call the Social Security Administration at to file a claim or contact your local Social Security office.

In person+

If you think you may be eligible for payments, visit your local Social Security office. You should call first to make an appointment.

Ssa Retirement Benefits Application Form

Social Security enrolls you in Original Medicare .

• Medicare Part A helps pay for inpatient care in a hospital or limited time at a skilled nursing facility . Part A also pays for some home health care and hospice care.
• Medicare Part B helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.

Other parts of Medicare are run by private insurance companies that follow rules set by Medicare.

• Supplemental policies help pay Medicare out-of-pocket copayments, coinsurance, and deductible expenses.
• Medicare Advantage Plan includes all benefits and services covered under Part A and Part B prescription drugs and additional benefits such as vision, hearing, and dental bundled together in one plan.
• Medicare Part D helps cover the cost of prescription drugs.

Most people age 65 or older are eligible for free Medicare hospital insurance if they have worked and paid Medicare taxes long enough. You can sign up for Medicare medical insurance by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium. To learn more, read .

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Social Security Disability Insurance

For SSDI, the document requirements are considerably broader and the application is lengthier. Along with the usual personal data , youll need to provide extensive documentation of your medical history and treatment and file an Adult Disability Report.

The SSDI process also includes an interview, in person or by phone. Youll find detailed information in Social Securitys Adult Disability Starter Kit.

When you can file: There is no minimum age for SSDI but you must have done at least some work in which you acquired Social Security credits.

Where to file:Online, by phone or in person.

How To Apply Online For Just Medicare

Are you within three months of turning age 65 or older and not ready to start your monthly Social Security benefits yet? You can use our online retirement application to sign up just for Medicare and wait to apply for your retirement or spouses benefits later. It takes less than 10 minutes, and there are no forms to sign and usually no documentation is required.

To find out what documents and information you need to apply, go to the .

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Social Security Forms For Disability Benefits

Even if you plan to file online, it is advisable to write out a rough draft on paper forms so that you dont forget to include important information when working online or when you are in a Social Security office filing in person. The base application for Social Security Disability is the SSA-16-BK, while the base application form for Supplemental Security Income disability is the SSA-8000-BK. Base application forms for disabled widows and adult children are the SSA-10 and SSA-4-BK, respectively. These last two forms can be found in the SSA Retirement/Dependent/Survivor Forms section of this website.

Whether you are applying for Social Security Disability as a disabled worker, a disabled widow, a disabled adult child or for SSI as an adult, in addition to the SSA-16-BK or SSA-8000-BK, you also have to complete an SSA-3368 to provide medical information, an SSA-3369 to provide your work history, and an SSA-827, which allows the Social Security Administration to collect information for the purpose of determining your eligibility. You may also want to use some of the other forms available in this grouping of forms to submit additional information about your limitations or special accommodations.

Please click on the link below to open your desired form in a separate browser window. You can then download the form from DisabilityResources.org directly to your computer.

Retirement And Spousal Benefits

Youll need to provide an array of personal and work information, including:

• Your date and place of birth.
• Start and stop dates for jobs held in the past two years .
• Military service, if applicable.
• The routing number of the bank where you want Social Security to deposit your payment, and the number and type of your account.

Social Security provides a complete checklist of what youll need for your application.

When you can file: The minimum age to apply for both retirement and spouse benefits is 62, but monthly payments are higher if you wait longer.

Where to file:Online, by phone or in person.

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Applying For Social Security Benefits

Social Security offers an online retirement, disability and Medicare application that you can complete in as little as 15 minutes by visiting: apply for retirement or Medicare only or apply for disability benefits.

It is so easy. Better yet, you can apply from the comfort of your home or office at a time most convenient for you. In most cases, once your application is submitted electronically, youre done. There are no forms to sign and usually no documentation is required. Social Security will process your application and contact you if any further information is needed.

You can apply online for retirement benefits if you:

• are at least 61 years and 9 months old
• are not currently receiving benefits on your own Social Security record
• have not already applied for retirement benefits and
• want your benefits to start no more than 4 months in the future.

This service is only for individuals applying under their own social security number.

If that is not your case, please request an appointment by completing our internet inquiry form.

Social Security Benefits for foreigners or non-U.S. Residents

If you are not a U.S. resident or a U.S. citizen, but worked over 10 years in the U.S., under your own Social Security number and are over the age of 62 and you would like to inquire about your eligibility to U.S. social security retirement benefits you can submit your inquiry completing our internet inquiry form.

Lost Or Stolen Federal Payments

Report your lost, missing, or stolen federal check to the agency that issued the payment. Its usually one of these paying agencies. If your documentation indicates its a different agency, and you need its contact information, look in the A-Z Index of U.S. Government Departments and Agencies.

To get an update on your claim, contact the Treasury Department Philadelphia Financial Center at 1-855-868-0151, option 1.

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Already Enrolled In Medicare

If you have Medicare, you can get information and services online. Find out how to .

If you are enrolled in Medicare Part A and you want to sign up for Part B, please complete form CMS-40B, Application for Enrollment in Medicare Part B . If you are applying for Medicare Part B due to a loss of employment or group health coverage, you will also need to complete form CMS-L564, Request for Employment Information.

You can use one of the following options to submit your enrollment request under the Special Enrollment Period:

Note: When completing the forms CMS-40B and CMS-L564:

• State I want Part B coverage to begin in the remarks section of the CMS-40B form or online application.
• If possible, your employer should complete Section B.
• If your employer is unable to complete Section B, please complete that portion as best as you can on their behalf and submit one of the following forms of secondary evidence:
• Income tax form that shows health insurance premiums paid.
• W-2s reflecting pre-tax medical contributions.
• Pay stubs that reflect health insurance premium deductions.
• Health insurance cards with a policy effective date.
• Explanations of benefits paid by the GHP or LGHP.
• Statements or receipts that reflect payment of health insurance premiums.

Some people with limited resources and income may also be able to get .

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The Parts Of Medicare

Social Security enrolls you in Original Medicare .

• Medicare Part A helps pay for inpatient care in a hospital or limited time at a skilled nursing facility . Part A also pays for some home health care and hospice care.
• Medicare Part B helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.

Other parts of Medicare are run by private insurance companies that follow rules set by Medicare.

• Supplemental policies help pay Medicare out-of-pocket copayments, coinsurance, and deductible expenses.
• Medicare Advantage Plan includes all benefits and services covered under Part A and Part B prescription drugs and additional benefits such as vision, hearing, and dental bundled together in one plan.
• Medicare Part D helps cover the cost of prescription drugs.

Most people age 65 or older are eligible for free Medicare hospital insurance if they have worked and paid Medicare taxes long enough. You can sign up for Medicare medical insurance by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium. To learn more, read .

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Apply Online For Disability Benefits

Social Security offers an online disability application you can complete at your convenience. Apply from the comfort of your home or any location at a time most convenient for you. You do not need to drive to your local Social Security office or wait for an appointment with a Social Security representative.

You can use the online application to apply for disability benefits if you:

• Are age 18 or older
• Are not currently receiving benefits on your own Social Security record
• Are unable to work because of a medical condition that is expected to last at least 12 months or result in death: and
• Have not been denied disability benefits in the last 60 days. If your application was recently denied for medical reasons, the Internet Appeal is a starting point to request a review of the medical determination we made.

• Print and review the Adult Disability Checklist.

  It will help you gather the information you need to complete the application.

We suggest that you have the following information at hand. It will make completing the application much easier.

We may ask you to provide documents to show that you are eligible, such as:

Important

We accept photocopies of W-2 forms, self-employment tax returns or medical documents, but we must see the original of most other documents, such as your birth certificate.

Mailing Your Documents

After we receive your online application, we will:

What We Will Ask You

Depending on the information you provide, we may need to ask other questions.

Note

You should also have your checkbook or other papers that show your account number at a bank, credit union or other financial institution so you can sign up for Direct Deposit, and avoid worries about lost or stolen checks and mail delays.

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How To Request Approval

To receive approval, the third party organization must first submit the following information to us on company letterhead:

• The title and form number to be reproduced
• A summary of how the reproduced form will be used by the requesting organization
• The services that the customer is receiving from the organization
• The requesting organization’s name and corporate address
• The requesting individual’s name and address
• The requesting individual’s area code and telephone number
• A draft of the form to be reviewed and
• A description of how the organization intends to provide only the most up-to-date edition of the forms.

Requests should be forwarded to:

Social Security Administration Office of Media and Logistics Management Forms Policy and Design Team 1330 Annex Building Baltimore, Maryland 21235

Or can be emailed to:

Upon consideration and review, requests to reproduce Social Security forms may be approved on a case by case basis. At such time, the organization will be issued a unique, identifying company code which must be printed on each page of the form in the lower left corner. If the approval process is not completed, we may not accept the organization’s reproductions when submitted to SSA by the organizations customers.

Reporting is easy, safe, and secure. You can reach the SSA-OIG online, by phone, mail, or fax.

Documents You Need When Applying For Social Security

When its time to apply for your Social Security benefits, youll need to have the following documents in hand:

• Your Social Security card
• Your original birth certificate, or a certified copy
• Proof of U.S. citizenship or lawful alien status
• Military service papers, if applicable
• Your W-2 form from the last year

If you cant access any of these documents for one reason or another, dont hold off on applying. Your local Social Security office can help you obtain certified copies or equivalent information, or you can submit them later on in the process. Delaying signing up for benefits could result in you losing benefits.

Note that the SSA can accept photocopies of some of these documents, such as your W-2 and tax returns. However, youll need to submit the original of other forms, such as your birth certificate.

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Next Steps For Apply For Ssdi Or Ssi Benefits

Evidence required by DDS for case documentation

Once you apply for disability benefits with the SSA, the Disability Determination Services , a division of the Massachusetts Rehabilitation Commission, will review your case. DDS will review medical information and vocational information, if necessary, that includes:

• A history of all work performed in the last 15 years
• A description of the physical demands and skill requirements for each job
• Educational history

When all required medical and vocational information is received, the disability examiner and staff physician and/or psychologist carefully evaluate each claim, using a sequential evaluation process.

The following people or agencies can help supply the information that is needed to process a claim for disability benefits.

• Treating physicians and psychologists
• Consultative examinations authorized by the DDS