How to Fill out Form HA-4632

If you have been denied Social Security Disability (SSD) benefits and need to request an appeal hearing, you will be required to complete a number of forms. Among these is the “Claimant’s Medications” form, also known as form HA-4632

This form requires that you list all of the prescription and non-prescription drugs you take. If you have already provided this information to the Social Security Administration (SSA) throughout the application and review process, you are still required to complete form HA-4632 in its entirety.

Why Form HA-4632 is Important

The “Claimant’s Medications” form is a vital component of the documentation that the Administrative Law Judge (ALJ) will review when examining your claim for SSD benefits. Listed medications can help demonstrate that your medical condition prevents you from maintaining gainful employment even though you’re doing all you can to manage and treat the condition.

How to Complete Form HA-4632

Typically, the SSD hearing office sends out form HA-4632 with the personal and claim information already filled in. If this section of the form is not completed upon arrival, you will need to fill in the blanks. If it is already filled out, you will need to verify the information and make any necessary corrections.

Other information requested on the form pertains to the details of your prescription and non-prescription medications. For each, you must list the same details, including the medication name, the date it was prescribed, the physician that prescribed it, the daily dose you take, and why the medication is required. When completing form HA-4632, be sure that you list every medication you currently take, including over-the-counter and prescription drugs.