Sample SOAR Application Packet - Child
Here are examples of completed SSA and SOAR Forms using information from a fictitious SSI child applicant.
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 (Updated 10/26/18)
- SOAR Checklist for Initial Claims (DOCX)
- SSA-827: Authorization to Disclose Information (PDF)
- SSA-1696: Appointment of Representative (1/7/21) (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 (Updated 10/26/18)
Resources
Files
Attachment | Size |
---|---|
SOAR_Checklist_Initial_Claims_Annie_Farnsworth.docx | 64.94 KB |
SSA_3820_Annie_Farnsworth_child.pdf | 1.32 MB |
Function_Report_Annie_Farnsworth_child.pdf | 650.87 KB |
ssa_5665_Teacher_Questionnaire_Annie_Farnsworth_2018.pdf | 849.8 KB |
ssa_561_Request_Recon_Annie_Farnsworth.pdf | 132.34 KB |
ha_501_Request_Hearing_Annie_Farnsworth_child.pdf | 1.17 MB |
SSA_3441_Appeal_Report_Annie_Farnsworth.pdf | 946.65 KB |
ssa_827_Recon_Annie_Farnsworth_child.pdf | 82.06 KB |
OTR_letter_Annie_Farnsworth.docx | 15.63 KB |
MSR Annie Farnsworth-child.pdf | 106.26 KB |
SSA_1696_Annie_Farnsworth_child.pdf | 276.72 KB |
Annie Farnsworth-SSA-8000-09.2019.pdf | 1.07 MB |
Annie_Farnsworth_SSA-827_032020.pdf | 1.18 MB |
Details
- Type:
- Sample Completed Application
- Date:
- October, 2018
Other Details
- Topic
- Medical Summary Report (MSR)
- Focus
- Youth