HA-4631 Form PDF Download : How To Fill Form HA-4631 PDF 2024

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HA-4631 Form PDF Download
HA-4631 Form PDF Download

HA-4631 Form PDF Download:- HA-4631 is an informational notice sent by the Social Security Administration (SSA) to inform you that your claim for disability benefits has been denied. The notice also provides information on how to request a reconsideration of the decision. The notice may also include information on how to appeal the decision to an Administrative Law Judge (ALJ).

What is the HA-4631 Form PDF?


Form HA-4631, officially titled “Claimant’s Recent Medical Treatment,” is a form used by the Social Security Administration (SSA) to gather information about a claimant’s medical history and treatment since their last medical records were submitted. This form is typically used in the context of a disability benefits claim or appeal.

The form asks the claimant to provide details about their medical treatment, including the names and contact information of their healthcare providers, dates of treatment, and diagnoses. It also inquires about any hospitalizations or surgeries the claimant has had.

Completing Form HA-4631 is crucial for ensuring that the SSA has a comprehensive understanding of a claimant’s medical condition and its impact on their ability to work. Accurate and complete information provided on this form can significantly strengthen a claimant’s case for disability benefits.

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Purpose of the HA-4631 Form PDF

The purpose of the HA-4631 Form PDF is to gather information about a claimant’s recent medical treatment and history in support of their claim for disability benefits. This form is typically used when a claimant is appealing a denial of benefits or requesting a reconsideration of a decision.

The information gathered on Form HA-4631 is used by the Social Security Administration (SSA) to determine whether the claimant meets the medical criteria for disability benefits. The form asks for information about the claimant’s medical providers, diagnoses, treatment, and hospitalizations.

Here are some specific purposes of Form HA-4631:

  • To document the claimant’s medical condition and its severity
  • To track the claimant’s medical progress or decline
  • To identify any new medical evidence that may support the claimant’s claim
  • To assess the claimant’s ability to work

Completing Form HA-4631 accurately and completely is important for several reasons:

  • It can help the SSA to make a more accurate decision about the claimant’s disability claim
  • It can prevent the SSA from requesting additional information, which can delay the processing of the claim
  • It can provide the claimant with a record of their medical history, which can be helpful for future medical appointments or insurance claims

Here are some tips for completing Form HA-4631:

  • Gather all of your medical records before you begin completing the form
  • Be as specific as possible in your answers
  • If you are unsure about how to answer a question, leave it blank and write “N/A”
  • If you need more space to answer a question, attach an additional sheet of paper
  • Sign and date the form at the end

You can submit Form HA-4631 to the SSA in several ways:

  • Mail it to the SSA’s Office of Hearings and Appeals
  • Submit it electronically through the SSA’s website
  • Fax it to the SSA
  • Take it to a local SSA office

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How to File Form HA-4631 in Detroit 2024

When you’re dealing with bad health and can’t work, Social Security disability income could be a financial lifeline for you. The trouble is, most people who apply get denied. If this happened to you, don’t give up. You have the right to appeal. And one of the key steps of any disability appeal is completing Form HA-4631. This form is called “Claimant’s Recent Medical Treatment.”

Once you receive a notice of denial, don’t wait to appeal. You face a 60-day deadline to start your appeal. If you wait too long, the Social Security Administration (SSA) may reject any forms you send. You’ll be forced to file a new application and start the process over. And before you spend a lot of time on this form, call a lawyer. At Levine Benjamin Law Firm, we can fill out Form HA-4631 for you.

WHAT INFORMATION DO I NEED TO COMPLETE FORM HA-4631?

This is what Form HA-4631 asks you to provide:

A list of all the doctors who have treated you Your medical providers’ contact information The dates you received treatment Names and addresses of any hospitals where you were hospitalized Reasons why you were hospitalized, if applicable Treatment you received in the hospital No matter where you are in the disability process, it’s crucial that you keep track of all your medical records.

Having those records strengthens your case. When you reach the stage of a hearing with a Social Security administrative law judge, your medical evidence and work history are the vital ingredients of your disability case.

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How to Fill out the form HA-4631 online


To fill out the HA-4631 form online, you will need to follow these steps:

  1. Access the form: Visit the Social Security Administration’s website (https://www.ssa.gov/forms/ha-4631.html) and navigate to the “Forms” section. Locate the “Claimant’s Recent Medical Treatment” (HA-4631) form.
  2. Start the online application: Click on the “Start Online Application” button located next to the HA-4631 form. This will redirect you to the Adobe Sign platform for completing the form electronically.
  3. Enter your email address: Provide a valid email address where you will receive instructions and a link to access the online form. Double-check the email address for accuracy and click the “Continue” button.
  4. Check your email: Open the email you received from Adobe Sign and click on the provided link to access the HA-4631 form.
  5. Sign in to Adobe Sign: If you already have an Adobe Sign account, sign in using your credentials. If you don’t have an account, you can create one for free by clicking on the “Create Free Account” option.
  6. Complete the form fields: Once signed in, you will be presented with the HA-4631 form. Fill out all the required fields, including your name, contact information, Social Security claim number, and details about your recent medical treatment.
  7. Sign and submit the form: Once you have completed all the fields, scroll down to the signature section. Click on the “Sign” button and follow the instructions to electronically sign the form. Then, click on the “Submit” button to finalize your request.
  8. Confirmation email: You will receive an email confirming your submission of the HA-4631 form. Keep this email for future reference.

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To complete the HA-4631 form, you will need to:

  1. Read Instructions: Carefully read any instructions or guidelines provided with the form. This will give you an overview of what information is required and how to fill out the form correctly.
  2. Gather Personal Information: Collect personal information such as your name, address, Social Security number, or any other identification details that the form may require.
  3. Provide Specific Details: Fill in the specific details requested on the form. This could include financial information, employment details, or other relevant information depending on the purpose of the form.
  4. Attach Supporting Documents: Some forms require supporting documents. These could be copies of identification, financial records, or other documentation that supports the information you provide on the form.
  5. Review and Confirm: Before submitting the form, review all the information to ensure accuracy. Mistakes or incomplete information may lead to delays or complications.
  6. Submit the Form: Follow the submission instructions on the form. This may involve mailing the form to a specific address, submitting it online, or delivering it in person.

How To Download HA-4631 Form PDF 2024

Form HA-4631 | Claimant’s Recent Medical Treatment

When you have requested, or are requesting, a hearing before an Administrative Law Judge (ALJ), use this form to tell us about medical treatment you have received since you, or someone on your behalf (for example, your representative or doctor), last furnished medical information to us.

HA-4631, Claimant’s Recent Medical Treatment

If you are not certain whether you told us about treatment you have received, or remember treatment that you forgot to tell us about, include that information also.

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Where to send this form

Complete the form and mail it 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.

How to Obtain the HA-4631 Form PDF

  1. Download from the Social Security Administration (SSA) website:
    • Navigate to the SSA’s website: https://www.ssa.gov/forms/ha-4631.html
    • On the form page, locate the “Download PDF” button and click on it.
    • The HA-4631 form will be downloaded in PDF format, allowing you to save it to your device.
  2. Request a copy from the SSA’s Office of Hearings and Appeals (OHA):
    • Contact the SSA’s OHA by phone at 1-800-772-1213 or by fax at 1-800-322-0772.
    • Inform the representative that you need a copy of Form HA-4631, “Claimant’s Recent Medical Treatment.”
    • Provide your name, Social Security number, and contact information to the representative.
    • The representative will mail a copy of the form to the address you provided.
  3. Visit a local SSA office:
    • Locate the nearest SSA office using the SSA’s online office locator: https://www.ssa.gov/locator/
    • Visit the office during regular business hours.
    • Inform the SSA staff member that you need a copy of Form HA-4631, “Claimant’s Recent Medical Treatment.”
    • The staff member will provide you with a printed copy of the form.

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Tips for Completing the HA-4631 Form PDF


Completing the HA-4631 form accurately and completely is crucial for supporting your claim for Social Security disability benefits. Here are some tips to help you fill out the form effectively:

  1. Gather all your medical records before you begin completing the form. This includes doctor’s notes, hospital records, test results, and any other relevant documentation of your medical condition and treatment.
  2. Be as specific as possible in your answers. Provide detailed information about your medical history, including the dates of treatment, diagnoses, medications, and any procedures or surgeries you have had.
  3. If you are unsure about how to answer a question, leave it blank and write “N/A” (not applicable). It’s better to leave a question blank than to provide inaccurate or incomplete information.
  4. If you need more space to answer a question, attach an additional sheet of paper. Clearly label the additional sheet with the corresponding question number and your name and Social Security number.
  5. Sign and date the form at the end. Your signature indicates that you have reviewed the information provided and attest to its accuracy.
  6. Keep a copy of the completed form for your records. This will be helpful for future reference or if you need to provide additional information to the Social Security Administration (SSA).

Here are some additional tips for completing specific sections of the form:

  • Section 1: Claimant Information: Ensure your name, Social Security number, and contact information are accurate and up-to-date.
  • Section 2: Treatment Provider Information: List all your healthcare providers involved in your recent medical treatment, including their names, addresses, and phone numbers.
  • Section 3: Treatment Received: For each healthcare provider listed in Section 2, provide details of the treatment you received, including dates of treatment, diagnoses, medications prescribed, and any procedures or surgeries performed.
  • Section 4: Hospitalizations: If you have been hospitalized for your medical condition, provide the dates of hospitalization, the names and addresses of the hospitals, and the reasons for hospitalization.
  • Section 5: Additional Information: If you have any additional information that you believe is relevant to your claim, provide it in this section. This could include information about your work limitations, daily activities, or any other factors affecting your ability to work.

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Conclusion – HA-4631 Form PDF Download


In conclusion, the HA-4631 form is a crucial document in the process of applying for or appealing a Social Security disability benefits claim. This form serves to gather detailed information about the claimant’s recent medical treatment and history, which is essential for the Social Security Administration (SSA) to make an informed decision about the claimant’s eligibility for disability benefits.

Accurate and complete information provided on the HA-4631 form can significantly strengthen the claimant’s case for disability benefits. By following the tips outlined in this guide and carefully completing the form, claimants can effectively present their medical history and treatment to the SSA.

Here are some frequently asked questions (FAQs) concerning the HA-4631 form:

Q 1. What is the purpose of the HA-4631 form?

The HA-4631 form, also known as the “Claimant’s Recent Medical Treatment” form, is used by the Social Security Administration (SSA) to gather detailed information about a claimant’s recent medical history and treatment. This information is crucial for the SSA to assess the claimant’s eligibility for Social Security disability benefits.

Q 2. Who needs to complete the HA-4631 form?

The HA-4631 form is typically completed by individuals who are:

  • Applying for Social Security disability benefits
  • Appealing a denial of Social Security disability benefits
  • Requesting a reconsideration of their Social Security disability benefits decision

Q 3. When should I submit the HA-4631 form?

The HA-4631 form should be submitted as soon as possible after you receive it from the SSA. Generally, the SSA will provide a timeframe for submitting the form, and it’s essential to adhere to that deadline to avoid delays in processing your claim or appeal.

Q 4. How do I obtain the HA-4631 form?

There are three primary ways to obtain the HA-4631 form:

  1. Download from the SSA’s website: Visit the SSA’s website (https://www.ssa.gov/forms/ha-4631.html) and locate the “Download PDF” button next to the form description. Click on the button to download the form in PDF format.
  2. Request a copy from the SSA’s Office of Hearings and Appeals (OHA): Contact the SSA’s OHA by phone at 1-800-772-1213 or by fax at 1-800-322-0772. Inform the representative that you need a copy of Form HA-4631, “Claimant’s Recent Medical Treatment.” Provide your name, Social Security number, and contact information, and the representative will mail you a copy of the form.
  3. Visit a local SSA office: Use the SSA’s online office locator (https://www.ssa.gov/locator/) to find the nearest SSA office. Visit the office during regular business hours and inform the SSA staff member that you need a copy of Form HA-4631, “Claimant’s Recent Medical Treatment.” The staff member will provide you with a printed copy of the form.

Q 5. What information do I need to provide on the HA-4631 form?

The HA-4631 form requires you to provide detailed information about your recent medical treatment, including:

  • Your name, Social Security number, and contact information
  • Names, addresses, and phone numbers of your healthcare providers
  • Dates of treatment, diagnoses, medications prescribed, and any procedures or surgeries performed
  • Details of any hospitalizations, including dates, names of hospitals, and reasons for hospitalization
  • Any additional information relevant to your claim, such as work limitations or daily activities affected by your medical condition

Q 6. How can I be sure I am completing the HA-4631 form correctly?

To ensure accuracy and completeness when completing the HA-4631 form, follow these guidelines:

  • Gather all relevant medical records before you begin filling out the form.
  • Be as specific as possible in your answers, providing detailed information about your medical history and treatment.
  • If you are unsure about how to answer a question, leave it blank and write “N/A” (not applicable).
  • Attach additional sheets of paper if you need more space to answer a question. Clearly label each additional sheet with the corresponding question number and your name and Social Security number.
  • Sign and date the form at the end to verify the accuracy of the provided information.
  • Keep a copy of the completed form for your records.

Q 7. What happens after I submit the HA-4631 form?

Once you submit the HA-4631 form, the SSA will review the information provided and assess its relevance to your claim or appeal. The SSA may contact you for additional information or clarification if necessary. The review process may take several weeks or months, and you will be notified of the decision regarding your claim or appeal by mail.

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