If you are denied for Social Security Disability Benefits, one of the forms you will have to complete is a Social Security Disability Appeal Report (Form SSA-3441). This form is part of the appeal process and helps your DDS examiner know where you are going to the doctor, the medications you take and information about how you are feeling. This form is lengthy and asks several questions about your disability that you may have to research to answer. Be sure that you include correct information when you fill out this form. Below is a discussion of the sections.

  • Section 1 – Information about the Disabled Person this section is basic questions about you. The important piece of this section is D. When you give the name of someone whom the SSA can contact about your condition make sure you put someone down who knows about your condition and WILL respond to the forms that SSA sends them.
  • Section 2 – Information about your Illnesses, Injuries or Conditions this section asks you about any changes in your medical condition and when those changes occurred. You should write down exactly what is going on with you or if you have been diagnosed with any new illnesses.
  • Section 3  – Information about your Medical Records this section is very important. This is how DDS knows what medical records to order on your case. Write down everywhere you have been for treatment. If you do not include all of this information DDS will not order the medical records and will make a decision on your case based on the records that they have.
  • Section 4 – Medications Please list your actual side affects from your medications. Do not write down the side affects that are listed on your medication bottle.
  • Section 5 – Tests If you have had any medical testing write down when and where it occurred.
  • Section 6 – Updated Work Information Have you been working? If so explain on a separate piece of paper or in the Remarks (Section 10).
  • Section 7 – Information about your activities How have your daily activities changed? Are you having problems bathing, cooking, cleaning, etc?
  • Section 8 – Education/Training Information Have you taken any classes since you became disabled?
  • Section 9 – Vocational Rehabilitation VR can help people find other jobs. If you have been to VR write down which VR you have been to and if they have done any testing on you.
  • Section 10 – Remarks – You can include any information that you could not fit into any of the sections above.

This form helps the Social Security Administration process your disability claim quickly. Your DDS examiner is not the only person who will see this form. Doctors at DDS or an Administrative Law Judge will view this document. At the Bishop Law Firm, we have helped many clients through the Social Security Disability Process. Be sure to complete SSA Disability Appeal Report Form SSA-3441 as soon as possible and return it to the Social Security Administration.

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