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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- 66
Agency:
Social Security Administration
Common Name:
Request for Evidence from Doctor or Hospital
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TYPE |
PAGES |
SIZE (KB) |
CAPABILITY |
WHAT'S NEEDED |
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Form Only
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0
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20
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[4] Fillable + Fileable
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Internet Explorer
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