Social Security Administration Forms
Although there are far more forms used by Social Security Disability Insurance the ones presented here are the most important. There are claims completed by you, your doctors and the claims examiners. They are as follows: Click on the title of the form to see a PDF of the report.
Forms Completed by the person filing the claim
Disability Report-Adult, SSA 3368-BK
Purpose: This is the application for Social Security Disability Insurance.
Adult Function Report, SSA 3373-BK
Purpose: This form is used by the caseworker to collect information about
your ability to function. It
covers daily activities, physical
capability and psychological issues.
Purpose: Completing this form and giving it to your medical resources allows
them to release medical
information to SSA.
Purpose: Provides SSA with additional information about how your disability
affects your ability to do
work for which you are qualified.
The information discloses the type of skills required for the job and
the physical and mental requirements
for each job.
Forms completed by Doctors
HIV Medical Report, SSA 4814-FS Doctor
Purpose: This form documents existing and past medical history for HIV
patients. If approved
claimants may receive early benefits.
Psychiatric Review Technique, SSA 2506-BK
Purpose: The information provided on this form will be used to make a
decision on a case involving
mental impairments.
Forms complete by the Claims Examiner, Medical Consultant, or Your Doctor
Mental Residual Functional Capacity Assessment, SSA 4734-SUP
Purpose: This form is completed for claimants with mental disabilities. It
documents the conclusions
gained from the case evidence. Mental
activities are evaluated within the context of your capacity to
sustain listed activities over a
normal workday and workweek, on an on-going basis.
Physical Residual Functional Capacity Assessment, SSA 4734-BK
Purpose: This form contains ratings for a variety of
physical limitations. It includes a brief section
of the evaluator’s judgment of the
symptoms presented in the application.
Forms Competed for Reconsideration Appeal
Request for Reconsideration - SSA-789-U4
Disability Report Appeal - SSA-3441-BK
Authorization to Disclose Information - SSA-827
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