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SSA-7162-OCR-SM 2021-2023 free printable template
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Form SSA7162OCRSM (012021) Discontinue Prior Editions Page 1 of 2 Social Security Administration OMB No. 09600049 REPORT TO THE UNITED STATES SOCIAL SECURITY ADMINISTRATION IMPORTANT: FAILURE TO COMPLETE
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How to fill out ssa 7162 2021-2023 form

How to fill out ssa 7162:
01
Obtain a copy of the SSA 7162 form from the Social Security Administration website or your local Social Security office.
02
Carefully read through the instructions provided on the form to understand the requirements and information needed.
03
Begin by filling out your personal information section, including your full name, Social Security number, date of birth, and contact information.
04
Provide information about your current medical condition or disability and its impact on your ability to work. Include details about any medical treatments or medications you are receiving.
05
If you have been employed in the past, provide details about your previous work history, including your job titles, dates of employment, and job duties.
06
If you are currently receiving any benefits, such as workers' compensation or state disability, indicate these on the form.
07
Attach any supporting documentation or medical records that can validate your disability or medical condition.
08
Review the completed form to ensure all information is accurate and legible.
09
Sign and date the form, and make a copy for your records before submitting it to the Social Security Administration.
Who needs ssa 7162:
01
Individuals who are applying for Social Security Disability Insurance (SSDI) benefits.
02
Individuals who are applying for Supplemental Security Income (SSI) benefits.
03
Individuals who have a disability or medical condition that prevents them from working and need to provide evidence of their disability to the Social Security Administration.
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