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)

DEVELOPMENT FORMS

Function Report – Adult

  • SSA-3373 Print and fill out by hand (426 kb)
  • SSA-3373 Fill out online, then print (426 kb)

Function Report – Adult Third Party

  • SSA-3380 Print and fill out by hand (426 kb)
  • SSA-3380 Fill out online, then print (426 kb)

APPEAL FORMS

Claimant’s Statement when ‘Request for Hearing’ is filed and issue is Disability. Disability Report Appeal

HEARING PREPARATION FORMS

Claimant’s Medical Treatment

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)