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Form SSA-3441-BK Disability Report-Appeal |
When to Use This Form |
APPEAL: The SSA-3441-BK (Disability Report-Appeal)
is the form used to update disability information. It is used in conjunction
with the
SSA-561-U2 (Request for Reconsideration), SSA-789 (Request for Reconsideration-Disability
Cessation), or HA-501 (Request for Hearing by Administrative Law Judge)
when filing an appeal based on disability. Before determining whether
you should complete this form, you need to refer to the SSA-561-U2, SSA-789,
and HA-501 and determine whether one of those forms is the appropriate
one to complete. If you are asked to complete form SSA-61, (Request For Review By A Federal Reviewing Official), it is available here. EVIDENCE: When you file the appeal request, you should give us any evidence you have that shows why the determination we made was incorrect. This would include copies of any medical records you have that we did not consider in our previous determination.
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How to Obtain the Form |
You may complete Form SSA-3441-BK online; OR You may download Form SSA-3441-BK Disability Report-Appeal in Portable Document Format (PDF) . The PDF permits you to print out a duplicate of the original form using ANY graphics printer. The PDF was developed by Adobe Systems, Inc. and allows the reader to print a publication close in appearance to the original printed version, preserving typography, columns, charts, tables and graphics. To read and print a PDF publication, you must have the Adobe Acrobat Reader software installed on your PC. Adobe Systems, Inc. permits the Social Security Administration and other organizations to offer this software to the public free of charge. If you do not already have this special software, see our page on downloading and printing PDF documents. After you download the Adobe Acrobat Reader, come back to this page and download the PDF version of the SSA-3441-BK below. PDF files are printer independent and should print easily on any graphics printer (i.e., laser, inkjet, dot-matrix).
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Other Information About Appeals |
Social Security Appeals Process Forms: |
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Where To Send The Form |
If you use the paper version SSA-3441-BK, print the form on 8 1/2 x 11 inch white paper, complete the form, fold in thirds, insert it in a standard size number 10 business envelope (4 1/8 x 9 1/2) and mail to your closest Social Security office. If you are not sure where your local office is located, try our Social Security Office Locator service or call 1-800-772-1213. |
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Last reviewed or modified Monday Jan 14, 2008 |