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  • Form SSA-3441 | Disability Report - Appeal
    Form SSA-3441 | Disability Report - Appeal When we make a decision on your claim, we send you a letter explaining our decision If you do not agree with our decision, you can appeal—that is, ask us to look at your case again
  • SSA-3441-BK
    Form SSA-3441-BK (09-2025) UF Discontinue Prior Editions Page 1 of 11 Social Security Administration OMB No 0960-0144
  • Social Security Forms | SSA
    About Forms All forms are free If you cannot find the form you need or require assistance completing the form, please go to the Contact Us link Submitting Forms and Supporting Documents You can electronically complete, upload, and submit select forms to Social Security using the Upload Documents feature You can also fax or mail any paper form to your local office, unless otherwise
  • SSA - POMS: DI 12095. 030 - SSA-3441-BK (Disability Report - Appeal . . .
    Use the SSA-3441-BK for all reconsideration and hearings appeal requests about disability issues Do not use the SSA-3441-BK for appeals to the Appeals Council
  • SSA - POMS: DI 81007. 050 - i3441 Disability Appeal - iAppeals - 11 16 2023
    TN 10 (11-23) DI 81007 050 i3441 Disability Appeal - iAppeals This section contains information specific to the i3441 - Disability Appeal
  • Disability Determination Ready Claim Process | Disability Benefits | SSA
    This page describes how to participate in the Disability Determination Ready Claim process and states what evidence you’ll need to submit along with your appeal
  • SSA Handbook § 529
    You will also need to complete a “Disability Report - Appeal” (form SSA-3441) and sign an “Authorization for Source to Release Information” (form SSA-827) to the Social Security Administration for any additional medical sources listed on the “Disability Report - Appeal” These are also available at the SSA website
  • SSA - POMS: DI 81020. 025 - Processing Electronic Reconsideration Cases . . .
    A Processing reconsideration cases when SSA-3441 not received from claimant When a claimant files a request for appeal, but does not provide the necessary forms, including the SSA-3441 (Disability Report – Appeal), the Field Office (FO) transfers the case to the Disability Determination Services (DDS) for a disability determination
  • Form HA-501 | Request For Hearing By Administrative Law Judge
    If you do not agree with the reconsideration decision we made on your application for benefits, you may request a hearing before an Administrative Law Judge (ALJ) To request a hearing, you may use this form or write a letter HA-501, Request For Hearing By Administrative Law Judge If you are not sure this is the form you should use, the Notice of Reconsideration (reconsideration determination
  • Form SSA-561 | Request for Reconsideration
    Form SSA-561 | Request for Reconsideration When we make a decision on your claim, we send you a notice explaining our decision If you don't agree with a decision we made, follow the process to request a change You can appeal – that is, ask us to reconsider a decision you don’t agree with Request a disability reconsideration: If you applied for Social Security or Supplemental Security





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