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ILITY INSURANCE BENEFITS I apply for a period of disability and/or all insurance benefits for which I am eligible under Title II and Part A of Title XVIII of the Social Security Act, as presently amended. 1. PRINT your name FIRST NAME, MIDDLE INITIAL, LAST NAME u 2. 3. Enter your Social Security Number u Check (X) whether you are u / 4. If this claim is awarded, do you want a password to use SSA's Internet/phone service? / Male Female Yes No Answer question 5 if English is not you.

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How to fill out the SSA-16-BK online

The SSA-16-BK form is used to apply for disability insurance benefits under the Social Security Administration. This guide provides clear, step-by-step instructions on how to successfully complete the form online, ensuring you provide all necessary information accurately.

Follow the steps to complete the SSA-16-BK online effectively.

  1. Click ‘Get Form’ button to access the SSA-16-BK form and open it in your preferred online platform.
  2. Begin by entering your first name, middle initial, and last name in the designated fields.
  3. Next, input your Social Security Number in the corresponding box.
  4. Indicate your gender by checking the appropriate box for either male or female.
  5. If you wish to use the SSA's online or phone services, indicate yes or no for obtaining a password.
  6. If English is not your preferred language, fill in question 5; otherwise, proceed to item 6.
  7. Provide your date of birth and the name of the state or foreign country where you were born.
  8. Answer whether a public record of your birth was made before you turned five years of age, including religious records.
  9. Indicate whether you are a U.S. citizen or an alien lawfully present in the U.S. and provide the date of lawful admission if applicable.
  10. If applicable, provide your name at birth and any other names you have used, along with any other Social Security numbers you've had.
  11. Enter the date you became unable to work due to your disabling condition.
  12. Answer whether you or someone on your behalf has filed any prior Social Security claims and provide the necessary details if so.
  13. If you served in the military, provide the relevant service details.
  14. Detail your work history in terms of employment and any potential earnings not covered by Social Security, if applicable.
  15. Explain the nature of your illnesses, injuries, or conditions that limit your ability to work, and respond to related questions about past income and additional benefits.
  16. Complete your personal declaration, sign the form, and provide any necessary contact information for processing.
  17. Once you finish filling out the form, save your changes and you will have the option to download, print, or share the completed form.

Start filling out your SSA-16-BK form online today to ensure a smooth application process.

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