93 lines
9.1 KiB
HTML
93 lines
9.1 KiB
HTML
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<title>Information You Need To Complete Your Disability Appeal</title>
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<body>
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<!-- BANNER -->
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<header class="banner" role="banner">
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<h1>Information You Need To Complete Your Disability Appeal</h1>
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<div class="last-modified">
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Last reviewed or modified
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10/23/2024
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</div>
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</header>
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<!-- END BANNER -->
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<!-- FORM NUMBER -->
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<section class="form-number">INFO-U-NEED</section>
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<!-- CONTENT -->
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<main class="content" role="main">
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<p>If you recently applied for Social Security disability benefits or Supplemental Security Income and were denied for medical reasons, you may request an appeal online. </p>
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<p>Use the checklist below to gather the information you may need to appeal our medical decision. </p>
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<!-- NOTE CONTAINER-->
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<div class="container-blue"> <strong>Note:</strong> Please print the pdf version of this page to use while you gather your materials.</div>
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<h3>Personal Information</h3>
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<ul style="list-style: none;">
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<li> <form>
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<input type = "checkbox" >Name, Social Security number, address, and phone number. </li>
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<li>
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<input type = "checkbox" ><a href="date.htm">Date of Denial</a> Decision. </li>
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<li><input type = "checkbox" >Representative's name, address, and phone number.</li></form>
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</ul>
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<h3>Medical Information</h3>
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<ul style="list-style: none;">
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<li> <form>
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<input type = "checkbox" >Name, address, and phone number of a friend or relative who knows about your medical condition.
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</li>
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<li> <input type = "checkbox" >Description of any change to your medical condition and any new medical conditions.
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</li>
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<li> <input type = "checkbox" >Name, address, phone number, and visit dates of all health care providers, type of treatments and tests since you last gave us medical evidence.</li>
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<li> <input type = "checkbox" >Name of any medicine (prescription or over-the-counter) you are currently taking, why you are taking it, any side effects, and the name of the doctor who recommended or prescribed the medicine.</li>
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<li> <input type = "checkbox" >Description of any change in your daily activities, work, and education.</li></form>
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</ul>
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<!-- NOTE CONTAINER -->
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<div class="container-blue"> <strong>Note:</strong> You may want to refer to your medical records and have your medicine containers available.</div>
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<h3 id="document">Supporting Documents</h3>
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<ul style="list-style: none;">
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<li> <form><input type = "checkbox" >
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If you have documents that support your appeal, they will help Social Security make a decision on your claim for disability benefits. Supporting documents include any medical report, form, or written statement related to your disability.
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</li>
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<li> <input type = "checkbox" >
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You will be asked if you wish to upload any supporting documents in electronic format prior to submitting your online appeal (.doc, .docx, .tif, .tiff, and .pdf are accepted).
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</li>
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<li> <input type = "checkbox" >After you submit your appeal, we will provide a cover sheet you can use to submit any documents you want us to include with your request.</li></form>
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</ul>
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</main>
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</script><a class="btn" onclick="printPage()">Print</a>
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