This form applies to SSI/DI disability applications filed on or after August 1, 2006. Review by a Federal Reviewing Official is the first appeal following the denial of an initial application under the new Disability Service Improvement (DSI) process.

Form SSA-1696-U4, Appointment of Representative, is limited to the appointment of an individual, not an entity, to act on behalf of a claimant in his/her dealings with SSA.  SSA is only authorized to release records to the representative named on the 1696 form, not to anyone else in that person’s firm or office.

These are the forms for the appeal after the Reconsideration. This appeal is a request for a hearing in front of an Administrative Law Judge (ALJ). The Request for Hearing and Disability Report both need to be filled out, along with Medical Authorization forms for new medical sources listed in the Disability Report. Please note that the Disability Report - Appeal (form SSA-3441-BK) has replaced the old “Claimant’s Statement When Request for Hearing is Filed and the Issue is Disability.”

This is the form required to appeal the decision of the Administrative Law Judge.

These are the forms needed for the first appeal of an SSA decision (e.g., initial denial of benefits). Please note that the Disability Report - Appeal (form SSA-3441-BK) has replaced the old “Reconsideration Disability Report.” In addition to Request for Reconsideration and Disability Report forms, SSA requires Medical Authorization forms (SSA-827) for each of the sources listed in the Reconsideration Disability Report.

This is the form to use to get permission to obtain information and/or records from SSA about a claimant or beneficiary you do not represent. The claimant or beneficiary may give consent to an individual or an organization to obtain the information and records.

PASS

Use this form to request a Waiver of an overpayment or a change in the rate at which SSA recoups the overpayment. By requesting a waiver, you admit that there is an overpayment but are claiming that you should not have to pay it back. DO NOT USE THIS FORM TO APPEAL AN OVERPAYMENT THAT YOU THINK IS INCORRECT OR FOR THE WRONG AMOUNT. TO APPEAL OVERPAYMENTS, USE THE REQUEST FOR RECONSIDERATION FORM (see Appeal Forms in this Section). THE REQUEST FOR WAIVER CAN BE FILED AFTER THE APPEAL IS RESOLVED. There is no deadline for requesting a waiver, but there is a 60 deadline for filing a Request for Reconsideration.