Disability Forms
- SSA-827 Authorization to Disclose Information to the Social Security Administration
- SSA-199 Vocational Rehabilitation Provider Claim
- SSA-545 Plan for Achieving Self-Support
- SSA-546 Worker’s Compensation/Public Disability Questionnaire
- SSA-820 Work Activity Report (Self-Employed Person)
- SSA-821 Work Activity Report
- SSA-1365 State Agency Ticket Assignment Form Ticket To Work and Self Sufficiency Program
- SSA-3368 Disability Report Adult
- SSA-3369 Work History Report
- SSA-3373 Function Report-Adult
- SSA-3375 Function Report-Child Birth to 1st Birthday
- SSA-3380 Function Report Adult-Third Party Form
- SSA-3381 Medical and Job Worksheet Adult
- SSA-3820 Disability Report, Child
- SSA-3881 Questionnaire for Children Claiming SSI Benefits
- SSA-5665 Teacher Questionnaire
Reconsideration and Appeals Forms
- SSA-561 Request for Reconsideration
- SSA-789 Request for Reconsideration – Disability Cessation
- SSA-3441 Disability Report-Appeal
- HA-501 Request for Hearing by Administrative Law Judge
- HA-520 Request for Review of Decision/Order of Administrative Law Judge
- HA-539 Notice Regarding Substitution of Party Upon Death of Claimant
- HA-4608 Waiver of Your Right to Personal Appearance Before an Administrative Law Judge
- HA-4631 Claimant’s Recent Medical Treatment
- HA-4632 Claimant’s Medications
- HA-4633 Claimant’s Work Background
Benefit Application Supporting Forms
Generally, we use these forms for people who have applied for benefits or are applying. We will let you know when you need to complete one of these forms.
- SSA-3 Marriage Certification
- SSA-3-SP Certificación de Matrimonio
- SSA-11 Request to Be Selected As Payee
- SSA-21 Supplement to Claim of Person Outside the United States
- SSA-25 Certification of Election for Reduced Spouse’s Benefits
- SSA-150 Modified Benefits Formula Questionnaire
- SSA-308 Modified Benefits Formula Questionnaire, Foreign Pension
- SSA-437 Complaint Form for Allegations of Discrimination in Programs or Activities Conducted by the Social Security Administration
- SSA-521 Request for Withdrawal of Application
- SSA-671 Railroad Employment Questionnaire
- SSA-723 Statement Regarding the Inferred Death of an Individual
- SSA-781 Certificate of Responsibility for Welfare and Care of Child
- SSA-783 Statement Regarding Contributions
- SSA-787 Physician’s/Medical Officer’s Statement of Patient’s Capability to Manage Benefits
- SSA-795 Statement of Claimant or Other Persons
- SSA-1372 Advanced Notice of Termination of Child’s Benefits
- SSA-1372-BK-FC Advance Notice of Termination of Child’s Benefits (Foreign Claims)
- SSA-2032 Request for Waiver of Special Veterans Benefits (SVB) Overpayment Recovery or Change in Repayment Rate
- SSA-2512 Pre-1957 Military Service Federal Benefit Questionnaire
- SSA-2519 Child Relationship Statement
- SSA-3885 Government Pension Questionnaire
- SSA-4111 Certification of Election for Reduced Widow(er)’s and Surviving Divorced Spouse’s Benefits
- SSA-4184 Self Employment Corporate Officer Questionnaire
- SSA-5666 Request for Administrative Information
- SSA-7008 Request for Correction of Earnings Record
- SSA-7104 Partnership Questionnaire
- SSA-7156 Farm Self Employment Questionnaire
- SSA-7157 Farm Arrangement Questionnaire
- SSA-7163 Questionnaire About Employment or Self Employment
- SSA-7163A Supplemental Statement Regarding Farming Activities