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M FOR DISABILITY BENEFITS CLAIMANT: READ THE FOLLOWING INSTRUCTIONS CAREFULLY 1. 2. 3. 4. 5. 6. USE THIS FORM IF YOU BECOME SICK OR DISABLED WHILE EMPLOYED OR IF YOU BECOME SICK OR DISABLED WITHIN FOUR(4) WEEKS AFTER TERMINATION OF EMPLOYMENT. USE CLAIM DB-300 IF YOU BECOME SICK OR DISABLED AFTER HAVING BEEN UNEMPLOYED MORE THAN FOUR (4) WEEKS. YOU MUST COMPLETE ALL ITEMS OF PART A - THE CLAIMANT S STATEMENT . BE ACCURATE. CHECK ALL DATES. BE SURE TO DATE AND SIGN YOUR CLAIM (SEE ITEM 12.

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The employee is ineligible for disability benefits if they perform any type of work for which wages or profit were received, even if performed at home. If an employee is unemployed, disability benefits may also be paid to replace unemployment insurance benefits lost because of illness or injury (WCL §207).

You can get a paper Claim for Disability Insurance (DI) Benefits (DE 2501) form by: Ordering a form onlineto have it mailed to you. Getting the form from your licensed health professional or employer. Visiting an SDI Office. Calling 1-800-480-3287 and selecting DI Information option 3 to request a paper form by mail.

You cannot work due to a medical condition; You cannot do work that you did before; We decide that you cannot adjust to other work because of your medical condition(s); and. Your disability has lasted or is expected to last for at least one year or to result in death.

Apply by phone: Call SSA at 1-800-772-1213 from 7 a.m. to 7 p.m. Monday through Friday. Apply in person: Visit your local Social Security office.

You can generally get disability for anxiety if your condition leaves you completely unable to work or unable to go through daily life on your own. However, the SSA has very strict criteria for who can get benefits because of anxiety or other mental health conditions.

If you are using this form because you became disabled after having been unemployed for more than four (4) weeks, your completed claim MUST be mailed to: Workers' Compensation Board, Disability Benefits Bureau, PO Box 9029, Endicott, NY 13761-9029.

Apply by phone: Call SSA at 1-800-772-1213 from 7 a.m. to 7 p.m. Monday through Friday. Apply in person: Visit your local Social Security office. (Call first to make an appointment.) There is no online SSI Application.

In order to be eligible for DI benefits, you must: Be unable to do your regular or customary work for at least eight days. Have lost wages because of your disability. Be employed or actively looking for work at the time your disability begins.

Neurological Disorders — Impairments including epilepsy, Parkinson's, muscular dystrophy, cerebral palsy, peripheral neuropathy and others that hamper mental and physical functioning. Hematological Disorders – Including Sickle Cell Disease, bone marrow failure and hemolytic anemias.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232