SSA Disability Appeal Report Form SSA - 3441

SSA Disability Appeal Report Form SSA - 3441
By Kimberly BishopMarch 27, 2013

If you are denied for Social Security Disability Benefits, one of the forms required is a Social Security Disability Appeal Report (Form SSA-3441).

Be sure to complete SSA Disability Appeal Report Form SSA-3441 as soon as possible and return it to the Social Security Administration. Call us today for a free case review or start online now.

When to use the FORM SSA-3441

In most disability cases, you will need to use the Form SSA-3441 twice or file an disability appeal online twice.

After you apply at the local Social Security Office or online (initial level), your case will be sent to DDS (Disability Determination Services) in Raleigh, NC or your local equivalent (for example in Georgia, its called Disability Adjudication Services).

At DDS, an examiner will review your file, send you forms (i.e. work history forms and 3rd party questionnaires for your family to complete) and order medical records on you. If you are denied, you will need to complete the Form 3441 to appeal or file a disability appeal online.

After you appeal, your case is sent back to DDS for another examiner (reconsideration) to look at your file. If you are denied again, you will again have to complete the Form 3441 to appeal or file a disability appeal online to have a hearing scheduled before an SSA Administrative Law Judge.

Read NC Social Security Disability Lawyer for an complete overview of the appeals process

SSA 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.

  1. Section 1--Information about the Disabled Person-This section is basic questions about you. Be sure to give the SSA your permanent contact information as they may use this information to contact you several months (or even years!) later. If you do move or change phone numbers, you will need to contact your local SSA office and let them know.
  2. Section 2—Contacts- Here you give the name of a person(s) whom the SSA can contact about your condition(s). Make sure you put someone down who knows about your condition(s) but most importantly will RESPOND to the forms that SSA sends them. In addition to completing forms that SSA sends, your "contacts" may be called if SSA is unable to locate you later.
  3. Section 3-Medical Conditions-This section asks 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 physical or mental conditions. Certain conditions trigger faster processing so please write down all diagnoses that your doctors have discussed with you.
  4. Section 4-Medical Treatment-This section asks about any recent treatment. Please answer  a) where you received the treatment b) the dates you received the treatment and c) the type of test(s) you had performed.  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, DDS will not order the medical records and will make a decision on your case based on the records they already have. If DDS does not have enough information from your medical treatment to make a decision on your disability claim, they may send you to a consultative examination (CE). As a matter of common sense, your treating physicians, who you have developed relationships with, can give a far more comprehensive view of your health versus a one time consultative examiner.
  5. Section 5—Other Medical Information—This section simply asks whether or not any other places that you have not mentioned before may have medical records of your physical and/or mental conditions.  An example of this would be a Workers Compensation case or a prison/correctional facility that may also have records.
  6. Section 6—Medicines—For this section, list all of your medications, the prescribing doctor, the reason you take the medication and the side effects that you actually have from the medication.  Do not just write down the side effects that are listed on the medication bottle.
  7. Section 7—Activities-Have your daily activities changed for better or worse?  If so, be ready to briefly describe those changes. Any new limitations with lifting, walking, standing or daily hygiene should be discussed.
  8. Section 8—Work and Education—Have you been working and/or taken any classes since you became disabled? If so, you can explain this in the separate area (Section 10-Remarks). If you are working, explain the number of hours worked, what you are doing at work and your hourly rate of pay. For classes, be sure to let SSA know if you are full time/part time, remote learning or if you are having an difficulties in your classes.
  9. Section 9—Vocational Rehabilitation, Employment, or Other Support Services—VR can assist people with finding jobs or maybe has provided you with testing.  Maybe you’ve participated  with an employment network under the Ticket to Work Program?  If so, be able to write down the name of the organization, the counselor/instruction/job coach that assisted you and the address. If Vocational Rehabilitation has provided you with a sheltered workshop, be sure to note you are working in a sheltered workshop.
  10. Section 10-Remarks—You can include any information that you could not fit into previous other sections here.

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. Providing incomplete information will not help you attain Social Security Disability benefits.

At the Bishop Law Firm, we have helped many clients through the Social Security Disability Process. We represent disability clients in RaleighDurhamFayettevilleCary, Rocky MountWilsonSmithfieldLouisburgChapel HillRoanoke Rapids , Winston SalemGarner, GreensboroGreenville and surrounding areas in North Carolina. Call us today for a free case review, (919) 615-3095.  or start online now.

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