Skip to Content
chevron-left chevron-right chevron-up chevron-right chevron-left arrow-back star phone quote checkbox-checked search wrench info shield play connection mobile coin-dollar spoon-knife ticket pushpin location gift fire feed bubbles home heart calendar price-tag credit-card clock envelop facebook instagram twitter youtube pinterest yelp google reddit linkedin envelope bbb pinterest homeadvisor angies

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 
 Print and fill out by hand (101 kb)
HA-4486 Fill out online, then print (157 kb)

Hearing Preparation

Disability Report Appeal 
 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

We’ve Built Our Firm on Trust