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)

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