List ALL providers you have seen, including ER visits, specialists, and mental health providers

If you have new conditions in addition to your original disability, list those as well

Keep seeing your doctors regularly — a gap in treatment weakens your case during CDR

Social Security Disabilityhard

Disability Report -- Appeal

SSA-3441-BK · SSA

Documents changes in medical condition since the last disability report. Required when appealing a denied SSDI/SSI claim with updated medical evidence.

Form Details

Total fields: 70
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Filled by: patient
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Where to Submit This Form

📬

Return to SSA at the address provided on the form

SSA mails this to current SSDI/SSI recipients.

🏢

In person at local SSA office

https://secure.ssa.gov/ICON/main.jsp

Filing Deadline

Within 30 days of receipt. Call SSA at 1-800-772-1213 for extensions.

Required Attachments

📎 Updated medical provider information (names, addresses, phone numbers, dates of visits)
📎 Updated medication list
📎 Any new test results, hospitalizations, or diagnoses

Processing Time

Part of the CDR process — 3-6 months for a determination.

What Happens Next

SSA will use this report to obtain your latest medical records and evaluate whether your disability continues. You may be scheduled for a consultative exam.

Tips for This Form

✓ List ALL providers you have seen, including ER visits, specialists, and mental health providers
✓ If you have new conditions in addition to your original disability, list those as well
✓ Keep seeing your doctors regularly — a gap in treatment weakens your case during CDR

More Social Security Disability Forms

SSDI Application

SSA-16-BK · SSA

Application for Social Security Disability Insurance Benefits. Requires detailed work history, earnings record, and medical condition documentation.

SSI Application

SSA-8000-BK · SSA

Application for Supplemental Security Income for aged, blind, and disabled individuals with limited income and resources. Must be completed via SSA interview.

Adult Disability Report

SSA-3368-BK · SSA

The most complex patient-facing disability form. 15 pages requiring complete medical history, all diagnoses, medications, treating providers, hospitalizations, and work history.

Work History Report

SSA-3369-BK · SSA

10-page report requiring detailed descriptions of all jobs held in the past 15 years including physical demands, tools used, supervision, and lifting requirements.

Function Report

SSA-3373-BK · SSA

10-page functional assessment covering ADL capacity, daily routines, social functioning, cognitive abilities, and physical limitations.

Authorization to Disclose Information

SSA-827 · SSA

Authorization allowing SSA to collect medical and other information from providers, hospitals, and other sources for disability determination.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the SSA or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.