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
- SOAR Checklist for Initial Claims (DOCX)
- SSA-8000: SSI Application (PDF)
- SSA-827: Authorization to Disclose Information (PDF)
- SSA-1696: Appointment of Representative (PDF)
- SSA-3368: Disability Report (1/7/21) (PDF)
- SSA-16: SSDI Application (PDF)
- Medical Summary Report (PDF)
Appeal Forms
Resources
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)