1. Birth Details:-If born outside the U.S.: Name of the country at birth and its current name, if changed.
-Permanent Resident Card number, if applicable.
2. Marital Status:
-Details of current and past spouses (if applicable).
-Dates and places of marriages and divorces.
3. Children’s Information:
-Details of children who are disabled before age 22, are under 18, or are 18-19 and still in school.
4. Employment Information for the Last Two Years:
Employer details, dates of employment, and earnings.
5. Self-Employment Details for the Last Two Years:
Type of business and total net income.
6. Banking Information for Direct Deposits:
Account type, number, and bank routing number.
7. Emergency Contact:
Name and contact information of someone who knows about your medical condition and can assist with your claim.
8. Medical Contacts:
Information on doctors, hospitals, and clinics including names, addresses, and details of visits.
9. Additional Medical Records:
Information from vocational services, workers' compensation, or legal representatives.
10. Employment History:
-Impact of your medical condition on your job capabilities and details of past employment.
11. Educational and Training Background:
-Highest educational level and details of any special job or vocational training.