Request for ALJ Hearing (SSA 501), Disability Report - Appeal (SSA 3441), and Medical Authorization (SSA 827)


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.”

Attachment Size
ssa_501_Request_for_ALJ_hearing.pdf (84.55 KB) 84.55 KB
ssa-3441.pdf (202.57 KB) 202.57 KB
8145_ssa-827.pdf (110.57 KB) 110.57 KB