Social Security Forms

Pre-Application

Workers Compensation/Public Disability Questionnaire
SSA-546 Print and fill out by hand (67 kb)
SSA-546 Fill out online, then print (159 kb)

Disability Report-Adult

SSA-3368 Print and fill out by hand (125 kb)
SSA-3368 Fill out online, then print (426 kb)

Work History Report

SSA-3369 Print and fill out by hand (80 kb)
SSA-3369 Fill out online, then print (385 kb)

Hearing Request

Claimant’s Statement when ‘Request for Hearing’ is filed and issue is Disability
HA-4486 Print and fill out by hand (101 kb)
HA-4486 Fill out online, then print (157 kb)

Hearing Preparation

Disability Report Appeal
SSA-3441-BK Print and fill out by hand (72 kb)

Medication List

HA-4632 Print and fill out by hand (46 kb)
HA-4632 Fill out online, then print (65 kb)

Recent Work History

HA-4633 Print and fill out by hand (216kb)
HA-4633 Fill out online, then print (231 kb)

Please Note:
All documents above are stored in Portable Document Format (.PDF) and require Acrobat Reader 5.0 or greater to view

Get Acrobat Reader

Click on this icon to download Acrobat Reader.

Request Information