SAMHSA SOAR

Sample SOAR Application Packet - Adult

Here are examples of completed SSA and SOAR Forms using information from a fictitious SSI/SSDI applicant.

Sample Completed SOAR Application Packets

These are scanned images. If you have accessibility issues, please contact us at soar@prainc.com. 

These sample packets are for a fictional applicant named "Annette Farnsworth," and is provided for informational purposes only.  These forms are not to be used for the SOAR Online Course: Adult Curriculum practice case.

Initial Claim

Appeal Forms

  • SSA-561: Request for Reconsideration (PDF)
  • HA-501: Request for Hearing by Administrative Law Judge (PDF)
  • SSA-3441: Disability Report - Appeal (PDF)
  • SSA-827: Authorization to Disclose Information (PDF)
  • SSA-3288: Consent for Release of Information (PDF)

Resources

Files

Available Files
Attachment Size
Farnsworth SOAR_Checklist_Initial_Claims.docx 60.92 KB
Farnsworth SSA-1696 10.04.19.pdf 284.51 KB
Farnsworth SSA-3368 10.04.19.pdf 577.18 KB
Farnsworth SSA-8000 10.04.19.pdf 1.11 MB
Farnsworth SSA-16 10.12.22.pdf 242.93 KB
MSR Farnsworth 10.04.19.docx 29.25 KB
Farnsworth_SSA-827_032020.pdf 616.44 KB
MSR Farnsworth 10.04.19.pdf 105.27 KB

Details

Type:
Sample Completed Application
Date:
January, 2017

Other Details

Topic
Medical Summary Report (MSR)

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