Disability Report--Appeal (Internet Version)

iAppeals Screens for the final PSA (May 24)

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Welcome!
This is the starting point to request a review of our medical decision about
your eligibility for disability benefits. There are two parts to this Internet
Appeal process: (1) an Appeal Request form; and (2) an Appeal Disability
Report that gives us more information about your condition. You can
complete both forms online. To appeal online, you may submit only an
appeal request (Part 1). We are asking you to also submit an Appeal
Disability Report (Part 2) because it will give us more information about you
and help us in processing your appeal. If you do not want to use the
Internet to request your appeal, there are Other Ways to Request an Appeal
or Complete a Disability Report.
NOTE: We use the term “claimant” to refer to the adult or child whose
disability decision is being appealed.
To be able to use this Internet process, the claimant must:
Have applied for benefits
Have received a “Notice of Disapproved Claim”, a “Notice of
Reconsideration”, or “Notice of Federal Reviewing Official Decision”, and
have the notice available when beginning this process. (If you do not
know which notice you received, refer to About Your Notice.)
Disagree with the disability decision
Live in the United States or one of its territories
If any of the above statements are not true, stop here
and contact Social Security!
Completing the Internet Appeal Process
The first part of your appeal is the Appeal Request. The next five pages
explain this request and help you get ready to provide the information we
need. The sixth page is the Appeal Request form. We will ask you to
provide information about your representative if you have one. You will be
able to review the information you provide before sending it to us
electronically. The Appeal Request is a short form and you must complete
and submit it in a single session. You will not be able to come back to it
later.
Part 2 of the two-part Internet process is completing the Appeal Disability
Report. We will walk you through completion of this report right after you
submit the Appeal Request. The Report asks you to tell us about any
changes that have occurred since the claimant last completed a disability
report. This includes information about the claimant’s condition, doctors or
other medical sources and treatment, work activity and education. You do
not have to complete this report all at once. Later we will tell you how to
return to an Appeal Disability Report that you had started earlier.
To start the Internet Appeal Request and Disability Report process,
select this button.
Start the Appeal
Already started an Appeal Disability Report? Then select this button.
Go Back to the Report I Already Started

If You Have Questions
Call our toll-free number, 1-800-772-1213. If you are deaf or hard of hearing,
call our toll-free “TTY” number, 1-800-325-0778. Representatives are
available Monday through Friday from 7 AM to 7 PM.
More Information about Disability and the Appeal Process
How the Disability Appeals Process Works
Your Right to Representation
Social Security’s Definition of Disability for Adults
Social Security’s Definition of Disability for Children
Internet Security Policy
Social Security’s Accessibility Policy
Privacy Information
Information about Social Security’s Disability Programs
Last edited 5/24/2007 2:55 PM

iAppeals Screens for the final PSA (May 24)

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About This Internet Appeal Process

Using Social Security Online Services
Using the Internet Appeal Request and Disability Report gives you:
Security and privacy for your information.
Step by step instructions and examples to help you complete the
Appeal Request and the Disability Report.
A process to collect information that applies to you, similar to the
interview process in a Social Security Office.
The ability to work at your own pace, stopping when you want and
coming back to finish later.
What You Will Need
The Internet Appeal Request and Disability Report process asks for
information about the adult or child whose disability decision is being
appealed (the “Claimant”) and his or her medical history.
For us to decide that the Claimant is disabled under the Social
Security Act and its regulations, you must give us as much
information as possible so that we can contact your doctors and
hospitals directly to get your medical records. It is important that you
give us the names, addresses, and dates of treatment for all your
doctors and hospitals. The list below provides details about what you
will need.
For Part 1: The Appeal Request
Your Social Security Number, name, address, and telephone
number, if you have one.
Your Notice of Decision.
Information about your Representative, if you have one. Use this
link for more information about having a Representative.
For Part 2: The Disability Report
The name, address including ZIP code, and telephone number of
someone else who knows about your illnesses, injuries and
conditions (referred to only as conditions from here on) and can
give us information about you. (Note: The instructions page for
Part 2 provides a link for ZIP code lookup, if you need it.)
A description of any changes in your conditions since you last
completed a disability report, including new physical and mental
limitations and new conditions.
The names, addresses including ZIP codes, and telephone
numbers for all doctors, hospitals, and clinics that you have seen
since you last completed a disability report, and the dates you
saw them.
The name of each medical test that you have had since you last
completed a disability report, when and where the test was done,
and who ordered it.
The name of each current prescription and over-the-counter
medicine that you take and the doctor who prescribed it.
Other Information
Third Party Links: Some Social Security Online pages contain links to
third party sites not operated by SSA. Those sites are not within our
control and may not follow the same privacy, security, or accessibility
standards as ours. We are not responsible for the content or availability
of those sites, their partners, or advertisers.
Previous Page

Last edited 5/16/2007 9:42 AM

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iAppeals Screens for the final PSA (May 24)

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Should You Use This Internet Appeal Process?
Not everyone will be able to complete this process online. You must
answer all of the following questions to help us determine if you should
use this Internet process or if it would be better for you to speak with a
Social Security representative.
Do you live in the
United States or one
of its territories/
commonwealths?

Yes

No

Did you receive a
notice of decision?

Yes

No

Continue

Last edited 5/24/2007 3:07 PM

iAppeals Screens for the final PSA (May 24)

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About Your Appeal

Thank you and welcome to the Internet Appeal Request.
Please answer the following questions to help us determine how to
guide you through the Internet Appeal process. If you are unsure of the
answers to any of these questions, please contact Social Security for
assistance.

Suffix (if any)

Claimant Name:
(Enter the First, Middle, and
Last Name of the person
applying for benefits.)

Claimant Social
Security Number:
Please enter the Social
Security Number without
dashes or hyphens.

Claimant date of
birth:
What is the date on
the “Notice of
Decision” you
received?
(If you do not know which
date we are referring to,
see What Is My Notice
Date?)

Continue

Last edited 4/6/2007 6:05 PM