Professional Documents
Culture Documents
https://secure.ssa.gov/i3368/msgpages/Cov001.jsp
CoverSheetforKimberlyMcClure
Ihaveappliedfordisabilityonline.IunderstandthattheinformationI
providedandsenttoSSAelectronicallywillbeusedinmakinga
decisiononthisclaimforbenefits.
Myaddress:
PoBox229
Bellevue,ID83313
Myphonenumber:
(208)7137366
Whennecessary,SSAcancontactthispersonwhoknowsabout
mycondition:
BarbaraGlahn
612S6thSt
Bellevue,ID83313
(208)9286913
Ihaveattachedthefollowingitems(checkallthatapply):
CopiesofMedicalRecordsIAlreadyHave
Other(Pleaselistbelow)
Nameofthepersoncompletingthisapplication:
KimberlyMcClure
Mailorbringto:
SOCIALSECURITY
1437FILLMOREST
TWINFALLS,ID833013380
https://secure.ssa.gov/i3368/msgpages/Cov001.jsp
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