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USSSARev. 03-2023

Official form guide

Form SSA-16: Application for Disability Insurance Benefits

Applies for Social Security Disability Insurance (SSDI) benefits for workers who can no longer work due to a severe, long-term medical condition.

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Form Overview

SSA Form SSA-16 - Application for Disability Insurance Benefits

Applies for Social Security Disability Insurance (SSDI) benefits for workers who can no longer work due to a severe, long-term medical condition.

An application for monthly SSDI benefit payments based on your Social Security work record.

Risk Radar

Scan points
  • 1Not applying promptly — delays reduce potential back pay; retroactive benefits are limited to 12 months.
  • 2Incomplete work history — SSA needs your complete work history to calculate benefits.
  • 3Not continuing medical treatment — gaps in treatment can weaken your disability case.
  • 4Not meeting the recent work test — you must have worked a minimum number of years in the decade before disability.

Plain English

File this form if you have worked and paid Social Security taxes but can no longer work due to a medical condition expected to last at least 12 months or result in death.

Submission Date

  • Filing date: Apply as soon as you become disabled. Benefits start after a 5-month waiting period from the date of disability onset.
  • Preparation window: collect IDs, supporting records, and signatures in advance.
  • Final review: verify names, dates, and required fields before submission.

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Glossary Terms

long-termmedical

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Field map

Compact field-by-field guide

11 fields

Personal Info

4 items

Full Name

Your legal full name.

Requiredtext
Social Security Number

Your SSN.

Requiredssn
Date of Birth

Your date of birth.

Requireddate
Place of Birth

City, state, and country of birth.

Requiredtext

Disability

2 items

Date Disability Began

When your disability prevented you from working.

Requireddate
Medical Conditions

Names of your disabling medical conditions.

Requiredtext

Work History

2 items

Last Day Worked

The last day you worked at a job.

Requireddate
Most Recent Employer

Your most recent employer's name and address.

Requiredtext

Banking

1 items

Payment Method

How you want to receive benefits (direct deposit or Direct Express card).

Requiredselect

Signature

2 items

Signature

Your signature certifying the application is true and complete.

Requiredsignature
Date

Date signed.

Requireddate

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Quick Facts

Workers under full retirement age who have paid into Social Security and are now unable to work due to a severe disability.
An application for monthly SSDI benefit payments based on your Social Security work record.
Apply as soon as you become disabled. Benefits start after a 5-month waiting period from the date of disability onset.
Apply online at ssa.gov, by phone, or in person at your local SSA office.
SSDI provides income replacement if a medical condition prevents you from engaging in substantial gainful activity.
Complete the application, provide your work history and medical information, then SSA will gather your medical records using Form SSA-827.

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Source transparency

Copyright & Licensing - US Government Forms

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Public DomainCreated by the U.S. federal government. Not subject to copyright (17 USC § 105). Freely copyable without restriction.
Public DomainCreated by the U.S. federal government. Not subject to copyright (17 USC § 105). Freely copyable without restriction.
Public DomainCreated by the U.S. federal government. Not subject to copyright (17 USC § 105). Freely copyable without restriction.
Public DomainCreated by the U.S. federal government. Not subject to copyright (17 USC § 105). Freely copyable without restriction.
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