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1. SIGNATURE OF WITNESS ADDRESS NUMBER AND STREET CITY STATE ZIP CODE ADDRESS NUMBER AND STREET CITY STATE ZIP CODE Form SSA-789-U4 09-2015 EF 09-2015 Use Prior edition until exhausted 12-2009 EF 12-2009 CLAIMS FILE PRIVACY ACT AND PAPERWORK REDUCTION ACT NOTICE Sections 205 a b 1631 c 1 A and B of the Social Security Act as amended allow us to collect this information. We will use the information you provide to determine your eligibility for disability benefits. SOCIAL SECURITY ADMINISTRATION REQUEST FOR RECONSIDERATION - DISABILITY CESSATION RIGHT TO APPEAR SEE REVERSE SIDE FOR PAPERWORK/PRIVACY ACT NOTICE NAME OF CLAIMANT NAME OF WAGE EARNER OR SELF-EMPLOYED PERSON If different from Claimant FORM APPROVED OMB No* 0960-0349 FOR SOCIAL SECURITY OFFICE USE ONLY DO NOT WRITE IN THIS SPACE FO Code Benefit Continuation SPOUSE S NAME AND SOCIAL SECURITY NUMBER COMPLETE ONLY IN SUPPLEMENTAL SECURITY INCOME CASE Foreign Language Notice DISABILITY SSI CHILD WORKER BLIND WIDOW I DO NOT AGREE W....

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Form SSA- 827 (.pdf) SSA and its affiliated State disability determination services use Form SSA-827, "Authorization to Disclose Information to the Social Security Administration (SSA)" to obtain medical and other information needed to determine whether or not a claimant is disabled.

Filling Out Form SSA-789 NAME OF CLAIMANT. If you're claiming benefits on your own behalf, put your own name here. ... NAME OF WAGE EARNER OR SELF EMPLOYED PERSON. If you're claiming SSDI based on someone else's income and work history, fill this box in with that person's name. ... SPOUSE'S NAME… ... TYPE OF BENEFIT.

What Is the Most Approved Disability? Arthritis and other musculoskeletal system disabilities make up the most commonly approved conditions for social security disability benefits. This is because arthritis is so common. In the United States, over 58 million people suffer from arthritis.

General information for recording statements on the SSA-795. Use an SSA-795 whenever a signed statement is required or desirable, except when we request some other form or questionnaire or we can readily adapt for the statement.

A. Overview of the SSA-789 The claimant, an appointed representative, a representative payee or other third party filing on the claimant's behalf can use the SSA-789 Request for Reconsideration to request reconsideration on an initial disability cessation determination.

What Percentage Of Disability Appeals Are Approved? It is not easy winning an appeal for a disability benefits decision made by the SSA as only 35% of appeals are approved. Fill out a 100% Free Case Evaluation on this page to find out if you qualify for disability benefits.

If you qualify for Supplemental Security Income (SSI), you could also receive back pay. Retroactive benefits might go back to the date you first suffered a disability—or up to a year before the day you applied for benefits. For SSI, back pay goes back to the date of your original application for benefits.

General information for recording statements on the SSA-795. Use an SSA-795 whenever a signed statement is required or desirable, except when we request some other form or questionnaire or we can readily adapt for the statement.

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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