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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:

(866) 383-4529

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Chúng Tôi Nói Tiếng Việt