How to fill out form SSA-1365

Ticket to Work is a Social Security program which enables disabled persons to work on a trial basis. The goal of the program is for disabled persons to find suitable employment which they can do despite their disabilities and which will allow them to be self-sufficient.

When you are approved for the Ticket to Work program, you are assigned a ticket holder number. This will be your Social Security Number with a special Ticket to Work (TW) suffix added.

Once you receive your Ticket to Work, you must assign it to either an approved Employment Network (EN) or your state’s Vocational Rehabilitation Agency (VR). To assign your Ticket, you must fill out Form SSA-1365. The Social Security Administration (SSA) can tell you where to find or how to contact your state’s Vocational Rehabilitation Agency and any approved Employment Networks in your area.

Much of Form SSA-1365 is filled out by the EN and/or state VR, but it’s important to fill out your parts properly. You can have a representative help you or fill out the paperwork for you if you prefer.

Filling out the form is simple and straightforward. Your EN or VR fills out most of it. Still, it’s important to make sure that everything is filled out properly. Incomplete or improperly filled out paperwork can result in delays. Following is a breakdown of what you need to include on Form SSA-1365:

  • Section A. This section is completed by the Employment Network or Vocational Rehabilitation Agency that you decide to work with. You will, of course, want to check over it to make sure it is completely filled out and that the information is correct to the best of your knowledge.
  • Section B. You or your representative fills this section out. Indicate whether you are filling it out yourself or with a representative by checking the appropriate box. Other than that, all you need to do is sign and date the form and have your representative (if you have one) do the same.

The form also contains a privacy statement which you may want to review. This section informs you of all the ways in which the information the SSA collects from you could potentially be used.

Form SSA-1365 can be turned in instead of your Individualized Plan for Employment. If you haven’t assigned your ticket yet, you will also have to submit information regarding your earnings over the past eighteen months.

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