Social Security Forms
PRE-APPLICATION
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
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
Recent Medical Treatment
HA-4631
Print and fill out by hand (243 kb)
HA-4631 Fill out
online, then print (259 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)
Please
Note:
All documents below are stored in Portable Document
Format (.PDF) and require Acrobat Reader 5.0 or greater to view
click on this icon to download Acrobat Reader 5.0
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