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)

WHAT IS WORKERS’ COMP?

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 5.0 or greater to view

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