Social Security Forms



PRE-APPLICATION FORMS

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 FORMS
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 FORMS
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)


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