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)