Worksheet 1
SSI & SSDI Non-Medical Documentation Checklist
(if not applicable, write N /A)
Name:DOB: / SSN:
Application date:
SSI
All applicants: / SSDI
All applicants:
______Photo ID / ______Birth certificate
______If own/rent, copy of mortgage/rent agreement / ______Copy of any current pay stubs
______If he or she doesn’t rent: name, address of person(s) providing in-kind help / ______List of dependents
______List of dependents / ______Proof of Worker’s Compensation or State Disability Insurance Benefits (benefits letter or check stubs)
______Ownership of vehicle(s)
______Copy of life insurance policy
______Most recent bank account statement, including any joint bank accounts
______Copy of certificates of deposit
______Copy of stock/mutual fund certificates
______Copy of bonds held in own name
______Copy of any land/houses, etc., proof of ownership
______Copy of burial contracts
______Copy of any other household income: pay stubs, other benefits, child support
Immigrants: / Immigrants:
______Proof of sponsorship — original / ______Proof of sponsorship — original
______Proof of citizenship or alien status — original / ______Proof of citizenship or alien status — original
______Birth certificate (may be required)