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
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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.
- 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)
|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|
|MSR Farnsworth 10.04.19.pdf||105.27 KB|
- Sample Completed Application
- January, 2017
- Medical Summary Report (MSR)