Forms Catalog Document - i3441 :-: SSA :-: Disability Report--Appeal

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Disability Report--Appeal

The SSA-3441-BK is used to secure updated medical and other information since the claimant??s last disability determination from claimants who are appealing an unfavorable disability determination. This information may be used for reconsideration or request for federal reviewing official review of initial disability determinations and continuing disability reviews as well as a request for a hearing. This information assists the State Disability Determination Services, federal reviewing officials, and administrative law judges in preparing for appeals and hearings and in issuing a decision. Respondents are individuals who appeal denial of Social Security disability income and Supplemental Security Income (SSI) benefits, cessation of benefits, or who are requesting a hearing.

Form #: i 3441
Agency: Social Security Administration
Common Name: Disability Report--Appeal (Internet Version)

	TYPE	PAGES	SIZE (KB)	CAPABILITY	WHAT'S NEEDED
	Both Form and Instructions	0	169	[5] Fillable + Fileable + Signable	Internet Explorer

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