Form SSA-16 Application for Disability Insurance Benefits

Social Security Benefits Application

SSA-16 (revised)

Paper Form SSA-16 (Application for Disability Insurance Benefits )

OMB: 0960-0618

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0960-0618 can be found here:

2024-11-06 - No material or nonsubstantive change to a currently approved collection
2022-08-25 - No material or nonsubstantive change to a currently approved collection

Document [pdf]

Download: pdf | pdf

SSA-16

*Page 4:

delete question #19

*Page 4:

Add the following question in red font.

File Type	application/pdf
File Modified	2017-04-20
File Created	2017-04-20

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