Fill out Form SSA-16 online

Who uses Form SSA-16

• Adults whose illness, injury or condition keeps them from working
• People applying for Social Security Disability Insurance (SSDI)
• People who are blind or have low vision and are applying for disability benefits
• Applicants who want a paper application to send or bring to a local Social Security office

Before you start

• Your Social Security number and any other Social Security numbers you have used
• Your birth certificate or other proof of birth, and proof of U.S. citizenship or lawful alien status if you were not born in the U.S., in case Social Security asks for them
• Names, dates of birth (or ages) and Social Security numbers (if known) of your current spouse and of former spouses the form asks about, with the dates and places of each marriage and how and when any marriage ended
• Full names of your unmarried children who may qualify, as described in item 12
• Names and addresses of everyone you worked for this year and last year, with the month and year the work began and ended, and your W-2 forms or self-employment tax returns for last year
• The date your condition kept you from working, details of any workers' compensation or other public disability benefits, and your bank routing and account numbers for direct deposit

How to fill out Form SSA-16

1. 1

   Items 1 to 7: about you

   Print your name and enter your Social Security number. Answer item 3 only if English is not your preferred language. Give your date and place of birth (item 4), your citizenship or lawful presence in the U.S. (item 5), your name at birth and any other names (item 6), and any other Social Security numbers you have used (item 7).

2. 2

   Items 8 to 10: your condition and other work systems

   In item 8, enter when you believe your condition became severe enough to keep you from working, even if you have never worked. Item 9 asks whether you or a spouse (or prior spouse) worked in the railroad industry for 5 years or more. Item 10 asks about Social Security credits under another country's system and which countries.

3. 3

   Item 11: marriages

   If you have ever been married, give details of your current marriage in 11(b), or write "None." In 11(c), list other marriages that lasted at least 10 years, ended because your spouse died, or meet the divorce-and-remarriage rule printed on the form. Item 11(d) covers a marriage of under 10 years that ended in divorce, to the now-deceased parent of your child who is under 16 or disabled. Use Remarks on page 5 if you need more space.

4. 4

   Item 12: children

   List the full names of your children (including adopted children and stepchildren) and dependent grandchildren (including stepgrandchildren) who are now, or were in the past 12 months, unmarried and either under 18, 18 to 19 and in elementary or secondary school full-time, or disabled with the disability starting before age 22.

5. 5

   Items 13 to 16: work and earnings

   Item 13 asks whether you had covered wages or self-employment income in every year from 1978 through last year, and if not, which years you did not. In item 14, list everyone you worked for this year and last year, starting with the most recent, with the month and year work began and ended; write "Not Ended" if you still work there, or "None" if you had no employer. Complete item 15 on self-employment even if you were an employee, and enter your total earnings for last year and so far this year in item 16.

6. 6

   Items 17 to 24: your ability to work and other benefits

   Say whether you are still unable to work, and if not, the date you became able to work (item 17). Say whether your condition is related to your work (item 18) and whether you are blind or have low vision (item 19). Item 20 asks about other public disability benefits such as workers' compensation, Black Lung or SSI; if you check "Other," you also need a Workers' Compensation/Public Disability Benefit Questionnaire. Items 21 to 24 ask about money from an employer on or after the date in item 8, a child under 3 living with you in years with no earnings, a dependent parent, and a parent or grandparent if you were unable to work before age 22.

7. 7

   Page 5: remarks, signature and payment details

   Use Remarks for explanations and anything that did not fit, and attach a separate sheet if you need more space. Sign and date the declaration, add a daytime phone number, and enter your direct deposit routing and account numbers with checking or savings (or check the Direct Express or Direct Deposit Refused box). Give your mailing address, city, state, ZIP code and county; if you live somewhere else, enter your residence address in Remarks. The witness section is only for an application signed by mark (X).

After you fill it out

The form says to send or bring the completed application to your local Social Security office; use the office locator on the official site to find yours. Social Security reviews your application and work history, and if you meet the non-medical rules, a state agency that works with Social Security makes the disability decision and may ask for more information or a medical exam at government expense. Page 7 is a receipt for your claim; it lists the changes you should report while your claim is pending and, if you are awarded benefits, how to report them.

Signing: The form asks you to sign in ink with your first name, middle initial and last name, so print it and sign by hand. If you sign by mark (X), two witnesses who know you must sign and give their full addresses, and your name must be printed in the signature block.

Questions about Form SSA-16

Official information

• Form SSA-16: information you need to apply for disability benefits
• Apply for disability benefits (online, phone or in person)
• Who can get Disability
• Find your local Social Security office

Page text last reviewed November 7, 2026.

Related forms

• Form SSA-827Authorization to Disclose Information to the Social Security Administration (SSA)
• Form SSA-3288Consent for Release of Information
• Form SSA-795Statement of Claimant or Other Person
• Form SSA-561Request for Reconsideration
• SF 1199ADirect Deposit Sign-Up Form