Forms
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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-3368Fill 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
Recent Medical Treatment
HA-4631 Print and fill out by hand (243 kb)
HA-4631 Fill out online, then print (259 kb)
Medication List
HA-4632 Print and fill out by hand (46 kb)
HA-4632Fill 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)