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 

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)

Please Note: 
All documents above are stored in Portable Document Format (.PDF) and require Acrobat Reader

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