Sample SOAR Application Packet - Child

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

 

This sample packet is for a fictional child applicant named "Annie Farnsworth," and is provided for informational purposes only.  These forms are not to be used for the SOAR Online Course: Child Curriculum practice case.

Sample Completed SOAR Application Packet for an Initial Claim

• SOAR Checklist for Initial Claims (PDF)
• SSA-827: Authorization to Disclose Information (PDF)
• SSA-1696: Appointment of Representative (PDF)
• SSA-8000: SSI Application (PDF)
• SSA-3820: Child Disability Report (PDF)
• SSA-3378: Child Function Report, Age 6 to 12th Birthday (PDF)
• SSA-5665: Teacher Questionnaire (PDF)
• Medical Summary Report (PDF)

Sample Completed 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)
• On the Record Request (PDF)