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)