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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
(iAppeals)
Agency:
Social Security Administration
Common Name:
Disability Report--Appeal (Internet Version)
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TYPE |
PAGES |
SIZE (KB) |
CAPABILITY |
WHAT'S NEEDED |
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Both Form and Instructions
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0
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588
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[5] Fillable + Fileable + Signable
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