HA-4633 Claimant's Work Background

When you have requested, or are requesting, a hearing before an Administrative Law Judge (ALJ), use this form to tell us about any work you have performed since you filed your claim for disability benefits.

If you are not certain whether you told us about work you have done, including work you may have done before you filed your application, include that work on this form.

To ensure that we have current medical information, you should also complete an HA-4631, Claimant's Recent Medical Treatment, and an HA-4632, Claimant's Medications.

Complete and sign form, and mail to the hearing office where your claim is located. The address and telephone number of the hearing office are on the letter acknowledging receipt of the request for hearing that was sent.


Availability: Usually ships the next business day.

HA-4633 Claimant's Work Background HA-4633$5.95