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

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-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)