SOCIAL SECURITY ADMINISTRATION FORMS

The Social Security Administration (SSA) has many forms to fill out in your quest for Social Security Disability Insurance (SSDI). The forms below ones are the most common. These forms are in PDF format.

Forms Completed By Person Filing Claim

• Disability Application-Adult, SSA 3368-BK:
  This is the application for Social Security Disability Insurance (SSDI).


• Adult Function Report, SSA 3373-BK:
  This form collects information about your ability to function.


• Medical Release, SSA 827:
  This form allows the release of your medical records to the SSA.


• Work History Report, SSA 3369:
  This form provides the SSA with information on how your disability affects your ability to do work.

Forms Completed By Doctors

• HIV Medical Report, SSA 4814-FS
  This form documents existing and past medical history for HIV patients. If approved claimants may receive early benefits.


• Psychiatric Review Technique, SSA 2506-BK
  The information provided on this form will be used to make a decision on a case involving mental impairments.

Forms Completed By Claims Examiner, Medical Consultant, or Your Doctor

• Mental Residual Functional Capacity Assessment, SSA 4734-SUP
  This form is completed for claimants with mental disabilities. It documents the conclusions gained from the case evidence.


• Physical Residual Functional Capacity Assessment, SSA 4734-BK
  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.