Forms


 

Form to appoint an attorney or representative:

Appointment of Representative Form: www.ssa.gov/forms/ssa-1696.pdf

 

Forms to file an Initial Application for SSDI or SSI benefits:

Application for Social Security Disability Insurance Benefits (Initial Application for SSDI): www.ssa.gov/forms/ssa-16-bk.pdf

Application for Supplemental Security Income Benefits (Initial Application for SSI): www.secure.ssa.gov/apps10/poms/images/SSA8/G-SSA-8001-BK-1.pdf

Adult Disability Report (Disability Report for SSDI and SSI): www.ssa.gov/forms/ssa-3368.pdf

Authorization to Disclose Information To The Social Security Administration (Medical Release Form/HIPPA Release): www.ssa.gov/forms/ssa-827.pdf

 

Forms to file an appeal of a denial of your SSDI or SSI claim:

Request for Hearing: www.ssa.gov/forms/ha-501.pdf

Request for Reconsideration: www.ssa.gov/forms/ssa-561.pdf

Disability Report-Appeal Form (Reconsideration Appeal and Hearing Appeal Form): www.ssa.gov/forms/ssa-3441.pdf

 

Additional forms often requested by SSA to process your claim:

Application for Child’s Insurance Benefits: www.ssa.gov/forms/ssa-4.pdf

Child’s Disability Report: www.ssa.gov/forms/ssa-3820.pdf

Claimant’s Medications: www.ssa.gov/forms/ha-4632.pdf

Claimant’s Recent Medical Treatment: www.ssa.gov/forms/ha-4631.pdf

Claimant’s Work Background: www.ssa.gov/forms/ha-4633.pdf

Function Report: www.ssa.gov/forms/ssa-3373-bk.pdf

Request for Social Security Earnings Information: www.ssa.gov/forms/ssa-7050.pdf

Work Activity Report: www.ssa.gov/forms/ssa-821.pdf

Workers’ Compensation/Public Disability Benefit Questionnaire: www.ssa.gov/forms/ssa-546.pdf

Work History Report: www.ssa.gov/forms/ssa-3369.pdf

 

Resources:

www.ssa.gov

www.webmd.com

www.medicinenet.com

www.medlineplus.gov

www.nlm.nih.gov

www.disability.gov

www.dol.gov/dol/topic/health-plans/erisa.htm

www.ssa.gov/people/veterans/