To prove that you’re disabled under the Social Security Act, you must show that you’re incapable of performing your past work and any other work that may exist in significant numbers in the national economy given your age, education, and acquired job skills. As a Richmond disability lawyer and Social Security attorney Virginia Beach, I think that employer questionnaires and statements are an effective way to support your testimony at the disability hearing that you’re not capable of working.


Sample Employer Questionnaire for Social Security Disability


Many administrative law judges schedule disability hearings for anywhere from 30 minutes to one hour. After procedural matters, claimant testimony, and vocational expert testimony, there is not much time left for testimony from other witnesses.


Because not much time is allowed to your disability hearing, it makes sense to submit as much supportive documentary evidence as possible. Instead of asking your former employer to come testify at hearing, your attorney can send a questionnaire to any former employers or coworkers who support your Social Security disability application and file the responses with the Social Security Administration’s (SSA) Office of Disability Adjudication and Review (ODAR).


The administrative law judge assigned to your case must review and explain the weight given to the employer’s statement in his or her written decision. If you do not receive a favorable decision and the judge failed to explain the weight given to the employer’s statement, you may have a valid basis for requesting review by the Appeals Council.


Below is a sample questionnaire we send to employers who have information that will help our clients win their claim for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits.


Re: John Doe


Dear Employer:


I represent your former employee, John Doe, in his claim for Social Security disability benefits. Please review the questions below and respond to the best of your ability.


  1. Please state your name, business address, telephone number, and email address.


  1. Please state how you know Mr. Doe (supervisor, co-worker, etc.).


  1. Please state the name and address of the business or organization where you and Mr. Doe worked together.


  1. Please describe the type of work performed by the business or organization where you and Mr. Doe are/were employed.


  1. Please state how long you have known Mr. Doe.


  1. Please state how often you saw/see Mr. Doe and whether you are/were able to observe his work.


  1. Do you believe that Mr. Doe is capable of working 8 hours a day, five days a week at any type of job without receiving additional breaks or accommodations? If not, why not? (i.e., cannot sit, stand, or walk for long at one time, would arrive late or have to leave early due to pain or mental health limitations, would have frequent absences, would have trouble getting along with coworkers, supervisors, or the general public, etc.)


  1. Please give example or stories that show the difficulties Mr. Doe had/has performing work activities on a consistent basis.


  1. Please check any of the following that apply to Mr. Doe:


_____  Allowed to take frequent rest breaks (more than the normal amount of allowed rest


_____  Allowed to work part-time or irregular hours as his health required;

_____  Absent more frequently than expected or allowed;

_____  Late to work more frequently than expected or allowed;

_____  Left work early more frequently than expected or allowed;

_____  Required and received special help from other employees in performing the job;

_____  Permitted to work at a slower pace or at a lower standard of productivity or efficiency  

           compared to other employees;

_____  Able to work only with specially arrangements, such as where other employees or

             persons could help him prepare for or get to and from work;

_____  Given the opportunity to work, despite his physical or mental impairments, because he

            is a family member, long-time friend, or member of a community organization that you

            are involved in;

_____  Given special work or equipment based on his physical or mental medical impairments.


Please explain any statements that you marked above and provide details:


Please sign and date below.


Signature: __________________________


Date: _______________



Have a question about our employer questionnaire and statement in Social Security disability claims? Think there is something we should add to the questionnaire to help our clients? Call, text, or email Corey Pollard today.