Application for Disability Insurance Benefits

Form SSA-16-BK (01-2015) ef (01-2015)
Page 7
RECEIPT FOR YOUR CLAIM FOR SOCIAL SECURITY DISABILITY INSURANCE BENEFITS
Person to Contact About Your Claim
Telephone Number (Include Area Code)
SSA OFFICE
Date Claim Received
Your application for Social Security disability benefits has
been received and will be processed as quickly
as possible.
You should hear from us within days after you
have given us all the information we requested. Some
claims may take longer if additional information is needed.
In the meantime, if you change your address, or if there
is some other change that may affect your claim, you
or someone for you — should report the change. The
changes to be reported are listed below.
Always give us your claim number when writing or
telephoning about your claim.
If you have any questions about your claim, we will be
glad to help you.
CLAIMANT SOCIAL SECURITY CLAIM NUMBER
CHANGES TO BE REPORTED AND HOW TO REPORT
FAILURE TO REPORT MAY RESULT IN OVERPAYMENTS THAT MUST BE REPAID
You change your mailing address for checks or residence.
To avoid delay in receipt of checks you should ALSO file a
regular change of address notice with your post office.
Your citizenship or immigration status changes.
You go outside the U.S.A. for 30 consecutive days or
longer.
Any beneficiary dies or becomes unable to
handle benefits.
Custody Change — Report if a person for whom you are
filing or who is in your care dies, leaves your care or
custody, or changes address.
You are confined to a jail, prison, penal institution or
correctional facility for more than 30 continuous days for
conviction of a crime, or you are confined for more than
30 continuous days to a public institution by a court order
in connection with a crime.
You become entitled to a pension, an annuity, or a lump
sum payment based on your employment not covered by
Social Security, or if such pension or annuity stops.
Your stepchild is entitled to benefits on your record and
you and the stepchild's parent divorce. Stepchild benefits
are not payable beginning with the month after the month
the divorce becomes final.
You have an unsatisfied warrant for more than 30
continuous days for your arrest for a crime or attempted
crime that is a felony of flight to avoid prosecution or
confinement, escape from custody and flight-escape. In
most jurisdictions that do not classify crimes as felonies,
this applies to a crime that is punishable by death or
imprisonment for a term exceeding one year (regardless
of the actual sentence imposed).
You have an unsatisfied warrant for more than 30
continuous days for a violation of probation or parole
under Federal or State law.
Change of Marital Status — Marriage, divorce, annulment
of marriage.
If you become the parent of a child (including an adopted
child) after you have filed your claim, let us know about
the child so we can decide if the child is eligible for
benefits. Failure to report the existence of these children
may result in the loss of possible benefits to
the child(ren).
You return to work (as an employee or self-employed)
regardless of amount of earnings.
Your condition improves.
You are under age 65 and you apply for or begin to
receive workers' compensation (including black lung
benefits) or another public disability benefit, or the
amount of your present workers' compensation or public
disability benefit changes or stops, or you receive a
lump-sum settlement.
HOW TO REPORT
You can make your reports online, by telephone, mail, or in person, whichever you prefer. If you are awarded benefits,
and one or more of the above change(s) occur, you should report by:
• Visiting the section "my Social Security" at our web site at www.socialsecurity.gov;
• Calling us TOLL FREE at 1-800-772-1213;
• If you are deaf or hearing impaired, calling us TOLL FREE at TTY 1-800-325-0778; or
• Calling, visiting or writing your local Social Security office at the phone number and address shown on your claim
receipt.
For general information about Social Security, visit our web site at www.socialsecurity.gov.
Page 7/7
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