Application for social security disability benefits appeal form

When we make a decision on your claim, we send you a letter explaining our decision. If you do not agree with our decision, you can appeal—that is, ask us to look at your case again.

If you applied for Social Security or Supplemental Security Income (SSI) disability benefits and were denied for medical reasons, you may request an appeal online.

If you do not wish to appeal online, you should submit:

• Form SSA-3441, Disability Report - Appeal;
• Form SSA-827, Authorization to Disclose Information to the Social Security Administration; AND
• One of these two forms (the letter you received from us should tell you whether you should request a reconsideration or a hearing):

Form SSA-561, Request for Reconsideration, if you are requesting a reconsideration of your claim; OR Form HA-501, Request for Hearing by Administrative Law Judge, if you are requesting a hearing.

Where to send this form

Send the completed form to your local Social Security office. If you have any questions, you may call us toll-free at 1-800-772-1213 Monday through Friday from 7 a.m. to 7 p.m. If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778.

Related Information

Publications

• Your Right to Question The Decision Made On Your Claim
• Your Right To Representation