Claimant's Work Background - Form HA-4633

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

How to Obtain the Form

Below you will this form in Portable Document Format (PDF). To print the PDF version, you will need the Adobe Acrobat reader software. If you do not already have this special software, you can download and install it for free at the Adobe website.

PDF files are printer independent using any printer. If you are using the software to view SSA forms, the form should be printed on 8 1/2" x 11" white paper. You must print the form with blue or black ink to be acceptable to SSA.

If you need further information, Customer Support is available at Adobe's website.

Please do not contact the Social Security Administration for problems or questions concerning the Adobe Reader software.

After you download the Adobe Acrobat Reader, come back to this page and download the PDF version of the HA-4633:

Claimant's Work Background, HA-4633

Send the Form

Where To Send The Form

Print the PDF HA-4633 form on 8 1/2 x 11 inch paper, 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 we sent.


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