Sample SOAR Application Packet - Adult

Sample Completed SOAR Application Packets

These are scanned images. If you have accessibility issues, please contact us at soar@prainc.com. 

These sample packets are for a fictional applicant named "Annette Farnsworth," and is provided for informational purposes only.  These forms are not to be used for the SOAR Online Course: Adult Curriculum practice case.

Initial Claim

• Annette's Case Worker - Harriet Jones - Sample SSA-1699
• SSA-3288: Consent for Release of Information (PDF)
• SSA-827: Authorization to Disclose Information (PDF)
• SSA-3368: Disability Report (PDF)
• SSA-16: SSDI Application (PDF)
• SOAR Checklist for Initial Claims (PDF)
• SSA-1696: Appointment of Representative (PDF)
• SSA-8000: SSI Application (PDF)
• Medical Summary Report (PDF)

Appeal Forms

• SSA-561: Request for Reconsideration (PDF)
• HA-501: Request for Hearing by Administrative Law Judge (PDF)
• SSA-3441: Disability Report - Appeal (PDF)
• SSA-827: Authorization to Disclose Information (PDF)
• SSA-3288: Consent for Release of Information (PDF)