The base forms used to file appeals are the SSA-561-U2 Request for Reconsideration (usually the first appeal), the HA-501-U5 Request for Hearing (usually second appeal, when your claim has been denied twice) and the HA 520-U5 for an Appeals Council review of a hearing denial. If you have been receiving benefits and your claim has been closed because it has been determined you are no longer disabled as defined by Social Security law, the appeal form to for first appeal is the SSA-789-U4. (The appeal will be a hearing within the Disability Determination Services (DDS) instead of only a DDS file review.)
Submit an SSA-827 with all appeals to re-authorize SSA to gather information to process your appeal. Use additional forms provided in this grouping to update your medical and vocational information when you file the appeal, to appoint an attorney or non-attorney representative, or to request a change of hearing date or location. We recommend that if you have a representative, discuss the pros and cons of requesting a change of hearing date before taking that action.
Please click on the link below to open your desired form in a separate browser window. You can then download the form directly to your computer.
SSA-1696-U4 Appointment of Representative (attorney or non-attorney)
SSA-3441-BK Disability Report – Appeal (to submit additional or updated medical information for reconsideration)
HA-4631 Claimant’s Recent Medical Treatment (to submit additional or updated information for hearing)
HA-4632 Claimant’s Medications (to submit additional or updated information for hearing)
HA-4633 Claimant’s Work Background (to submit additional or updated information for hearing)
Related Social Security Administration Forms For:
Retirement, Dependent & Survivors Benefits
Social Security Disability Insurance (SSDI) Benefits
Supplemental Security Income (SSI) Benefits
SSDI Work After Disability Approval
Representative Payee, Earnings Record, Direct Deposit & Overpayment