Disability Determination Package Form [new] [ INSTANT — 2024 ]

If you are looking for the (e.g., the SSA-3368 for US Social Security), please visit your local government’s benefits website (e.g., ssa.gov ). The text above is a generic template designed to help you prepare your information before filling out the official paperwork.

Please list all physical or mental conditions that limit your ability to work. Include the date each condition began. disability determination package form

(Add additional sheets if necessary)

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