When dealing with the complexities of managing disability benefits through the Social Security Administration (SSA), individuals may encounter various forms, one of which is the Title 2 Omb No 0960 0511, also known as the Disability Update Report. This form plays a crucial role in ensuring the SSA has the most current information regarding a beneficiary's disability status, which in turn, helps in the continuous evaluation of their eligibility for benefits. The form is designed to gather updated personal information, work activity, and any significant changes in the beneficiary's condition or treatment that could affect their disability status. Its structure is governed by the Privacy Act Statement, which outlines the collection and use of personal information, ensuring that the rights and privacy of the individuals are protected. The form also adheres to the Paperwork Reduction Act, reflecting the SSA's commitment to minimizing the paperwork burden on individuals while collecting essential information efficiently. With sections requiring details on work history, monthly earnings, and reasons for medical visits, the form is a comprehensive tool for beneficiaries to report significant updates that could influence their continued eligibility for SSA disability benefits.
Question | Answer |
---|---|
Form Name | Title 2 Omb No 0960 0511 Form |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | socialsecurity, ssa form 0960 0511, fax disability update report 455, ssa form omb 09600511 |
|
FORM APPROVED |
SOCIAL SECURITY ADMIISTRATIO |
OMB O. 09600511 |
|
|
DISABILITY UPDATE REPORT
Privacy Act Statement
Collection and Use of Personal Information
!""#"$$"%& $"&%&'"()*+*
, ,"
0 "
(****+) ,".)+)
* "(*
)**+),) 1
56*783
* "
(*+* * "9 * *)0*,
+ ": * ,,+*8
,,* **/,* "
*+,#;!%&
* +,)))"" +"
Paperwork Reduction Act Statement
?*)0#&&"@)/)*+59
)/":
|
|
|
|
; |
!;, |
"(+)0,*A
@;
If yes, please complete the information below.
Work Began |
|
Work Ended |
Monthly |
|
||
(month/year) |
|
(month/year) |
Earnings |
|
||
" |
2 |
|
2 |
|
B |
|
" |
2 |
|
2 |
|
B |
|
" |
2 |
|
2 |
B |
|
|
|
|
|
|
|
|
|
SSA455
" |
!0,0),,)1 |
|||||||||||||||||||||||||
|
|
|
|
|
|
|
( |
|||||||||||||||||||
|
|
|
|
|
|
|
|
|||||||||||||||||||
" |
()0A |
|||||||||||||||||||||||||
|
|
|
|
|
|
@ |
|
|
|
|
|
|
; |
|
|
|||||||||||
$" |
(+)0 * A |
|||||||||||||||||||||||||
|
|
|
|
|
|
@ |
|
|
|
|
|
; |
||||||||||||||
" |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(,+ |
,+* |
|||||||||||||||||||||||||
|
,0)0A |
@ |
|
|
|
|
|
; |
||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||
" |
(+,*' A |
|||||||||||||||||||||||||
|
|
|
|
|
|
@ |
|
|
|
|
|
; |
||||||||||||||
|
If yes, please list below: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||
|
Reason |
|
|
|
|
|
|
Date: (month/year) |
||||||||||||||||||
|
" |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
" |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
" |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||
>" |
(+ A |
|||||||||||||||||||||||||
|
|
|
|
|
|
@ |
|
|
|
|
|
|
; |
|
|
If yes, show the date and the reason for the visit.
"6
#
"6
#
"6
#
:**C:+D
* ,0) ":
)0) + ,
,**
,"
Sign |
6 |
|
Here |
|
SSA455