How to Fill out Form HA-4633

After being denied Social Security Disability (SSD) benefits, you’ll need to request an appeal. Following your formal request for an appeal, you will be required complete a number of forms, including the HA-4633.

The HA-4633 is the “Claimant’s Work Background” form, to complete it you will need to detail your previous employment, dating back 15 years. Although you’ve already given the SSA this information at least once, you must still fill out the entire HA-4633 form prior to your appeal hearing.

Why Form HA-4633 is Important

The HA-4633 form is a central piece of the documentation the Administrative Law Judge (ALJ) will review when going over your claim for SSD benefits. The positions you held as well as the duties you performed in each job will be examined closely by the ALJ. Your job duties will also be compared with your medical records to determine if your disability truly prevents you from seeking and maintaining employment.

How to Complete Form HA-4633

The top section of the HA-4633 form is filled out by the SSD hearing office, but you should review, verify, and, if necessary, correct the information listed before returning the form to the SSA. Other details you will be asked to provide on the Work Background form pertain to your previous employment and job duties.

Be sure to list each job you held during the last 15 years along with the dates of employment, and job duties required of each position. The form only provides predefined spaces for four jobs. If you had more than four jobs within the last decade and a half, you will need to attach additional pages to provide the required information.

Because the “duties performed” section of the HA-4633 form is so important to your eligibility for SSD benefits, it’s advisable that you seek the assistance of a Social Security advocate or attorney to help you complete the form and prepare you to answer any questions that the ALJ may ask you during the hearing.