Social Security Disability Application Letters
These links are either to actual SSA forms or generic forms to collect information for your case. Some forms are standard from SSA. However, some DDS agencies provide different versions of standardized forms to collect information on claimants. So, the actual forms and the information collected varies by state.
Initial Filing Letters
Letters from the Social Security Administration after filing for benefits. These letters are during the Initial Application stage which is prior to decisions or appeals.
Medical Records Release Authorization to Disclose Information to the Social Security Administration Form SSA-827 OMB No. 0960-0623
Request for Medical Records
Notice of Medical Records not Received
Disability Report – Adult Form SSA-3368 OMB No. 0960-0579
Disability Report – Child Form SSA-3820 OMB No. 0960-0577
Adult Function Report Form SSA-3373-BK OMB No. 0960-0681
Adult Funtion Report – Third Party Form SSA-3380-BK OMB No. 0960-0635
Activities of Daily Living (ADL) Questionnaire Form (This is part of the Adult Function Report, see Section C of Adult Function Report)
Notice for Consultive Exam
Work History Report Form SSA-3369-BK OMB No. 0960-0578
Work Activity Questionairre Form for Unsuccessful Work Attempt Form SSA-3033 OMB No. 0960-0483
Supplemental Forms: These are not standard SSA forms. For specific conditions like, Pain, Fatigue, etc. the state DDS use their own in-house forms. These are just examples and the questions may be different than forms you may receive. You may not be requested to submit some of these forms, but your doctor’s medical opinion can help you qualify for Social Security Disability benefits. So if you are alleging certain impairments, it may be helpful to use and submit these to proactively provide medical documentation for evidence in your case. For this reason, they are noted below as Supplemental forms.
Here are many additional RFC forms that are specific to various conditions.
Reconsideration Request Letters
Letters from the Social Security Administration after appealing an unfavorable decision. These letters are during the first appeal stage, Reconsideration Request, of the social security application process.
Physical Residual Functional Capacity RFC Assessment Form SSA-4734-BK OMB No. 0960-0431
Mental Health Residual Functional Capacity RFC Assessment Form SSA-4734-F4-SUP Range of Motion
Medical Appointment Reminder
Reconsideration Request Denial
Disability Report-Appeal SSA-3441-BK OMB No. 0960-0144
Claimant’s Recent Medical Treatment HA-4631 OMB No. 0960-0292
Claimant’s Medications HA-4632 OMB No. 0960-0289
Claimant’s Work Background HA-4633 OMB No. 0960-0300
Request for Hearing by Administrative Law Judge HA-501 OMB No. 0960-0269
Administrative Law Judge Hearing Letters
Letters from the Social Security Administration after requesting a hearing for review of an appeal by an Administrative Law Judge (ALJ). These letters are during the second appeal stage of the social security application process.
Letter of Support
Letter from ODAR
Internal Medical Exam
Disability Determination Services Review
Request for Review of Hearing Decisions/Order HA-520 OMB No. 0960-0277
Appeals Council or Federal Court Letters
Letters from the Social Security Administration after requesting an Appeals Council Review or filed a lawsuit in Federal Court. These letters are after a claim has been denied by an Administrative Law Judge.
Appeals Council Request for Review and Brief
Appeal Council Denied
Appeals Council 25-Day Letter
Affidavit of Financial Status
2nd Remand Notice
Appeals Counsel Decision Notification
After Favorable Decision Letters
Letters from the Social Security Administration after being approved and awarded SSDI benefits.
U.S. Treasury Release Form
Receipt for Children’s Benefits
Return to Work Letter
Annual Benefits Statement
Advance Notice of Termination of Child’s Benefits Form SSA-1372-BK OMB No. 0960-0105
Work Activity Report Form SSA-821 OMB No. 0960-0059
Work Activity Report Self Employed Form SSA-820 BK OMB No. 0960-0598