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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

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)

In Garden Grove:

13252 Garden Grove Blvd, #222
Garden Grove, CA 92843

(714) 750-6000

In El Monte:

11100 Valley Blvd., Suite 224
El Monte, CA 91731

(626) 582-8260

Call Now Toll Free:

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Serving Orange County: Aliso Viejo, Anaheim, Balboa Island, Brea, Buena Park, Capistrano Beach, Corona Del Mar, Costa Mesa, Coto de Caza, Cowan Heights, Cypress, Dana Point, El Modena, El Toro, El Toro Marine Base, Foothill Ranch, Fountain Valley, Fullerton, Garden Grove, Huntington Beach, Irvine, La Habra, Laguna Beach, Laguna Hills, Laguna Niguel, Lake Forest, Leisure World, Lemon Heights, Los Alamitos, Mission Viejo, Modjeska Canyon, Newport Beach, Orange, OC, Orange Park Acres, Placentia, Rancho San Margarita, Rossmoor, San Clemente, Santa Ana, Seal Beach, Silverado Canyon, Stanton, Sunset Beach, Surfside, Tustin, Villa Park, Westminster, Yorba Linda

Serving Riverside County: Aguanga, Anza, Arlington, Calimesa, Casa Blanca, Cherry Valley, Corona, Corona Hills, Edgemont, El Cerrito, Gilman, Glen Avon, Glenn Valley, Hemet, High Grove, Home Gardens, Homeland, Hot Springs, Idyllwild, La Sierra, Lake View, Mead Valley, Meadow Brook, Mira Loma, Moreno Valley, Mt. Lanter, Murrieta, Norco, Nuevo, Pedley, Perris, Quail Valley, Riverside, Rodea, Romoland, Sage, San Jacinto, Santa Ana Canyon, Soboba, Sun City, Temecula, Temescal Canyon, Vail Lake, Valle Vista, Wildomar Lake, Winchester

Serving Los Angeles County: Arleta, Bel Air, Canoga Park, Chatsworth, Crenshaw, Downtown Los Angeles, Eagle Rock, Echo Park, Encino, Granada Hills, Highland Park, Hollywood, Koreatown, La Brea, Lakeview Terrace, Los Feliz, Mar Vista, Miracle Mile, Mission Hills, North Hills, North Hollywood, Northridge, Pacific Palisades, Pacoima, Panorama City, Porter Ranch, Reseda, San Pedro, Sepulveda, Sherman Oaks, Silverlake, Studio City, Sunland, Sun Valley, Sylmar, Tarzana, Toluca Lake, Tujunga, Van Nuys, Venice, Watts, West Los Angeles, Westwood, Winnetka, Woodland Hills