Forms Catalog Document - HA-67 :-: SSA :-: Request for Evidence from Hospital

Forms.gov - The U.S. Government's Official Hub for Federal Forms

Skip Navigation

Home

Forms FAQs

Give Feedback

Locate a Form

By Agency

By Agency/Subagency

By Form Number

By Form Name(A-Z)

Frequently Used Forms

Tax Forms

Small Business Forms

Social Security Forms

Veteran Benefit Forms

FEMA Forms

Request for Evidence from Hospital

Claimants are required to provide medical evidence of their impairment(s)in pursuing a disability claim. SSA uses these forms to request medical evidence from sources (doctors and hospitals) where the claimant has been treated, seen or otherwise evaluated. Respondents are doctors and hospitals where the claimant has been evaluated.

Form #: HA- 67
Agency: Social Security Administration
Common Name: Request for Evidence from Doctor or Hospital

	TYPE	PAGES	SIZE (KB)	CAPABILITY	WHAT'S NEEDED
	Form Only	0	23	[4] Fillable + Fileable	Internet Explorer

Still Cannot Find a Specific Form Here?

If you do not find the form you need in the E-Forms Catalog we suggest:

Search through the Agency Forms links.

Search USA.gov, a connection to the U.S. Government's information and services.

Search GSA (GS), Standard (SF) and Optional (OF) Forms, the General Services Administration's library for GSA internal forms and government-wide Standard and Optional Forms.