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
SSA-3441-BK  Print and fill out by hand (72 kb)
SSA-3441-BK  Fill out online, then print (72 kb)

HEARING PREPARATION FORMS

Claimant’s Medical Treatment
SSA-4631-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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