OMB control number
Claimant's Medications
OMB 0960-0289 · SSA.
In cases where claimants request a hearing after denial of their disability claim for Social Security, SSA uses Form HA-4632 to request information from the claimant regarding the medications they use. This information helps the judge overseeing the case to fully investigate: (1) the claimant’s medical treatment and (2) the effects of the medications on the claimant’s medical impairments and functional capacity. The judge makes the completed form a part of the documentary evidence of record, placing it in the official record of the proceedings as an exhibit. The respondents are applicants (or their representatives) for OASDI benefits or SSI payments who request a hearing to contest an agency denial of their claim.
The latest form for Claimant's Medications expires 2028-07-31 and can be found here.
Document Name |
|---|
Form |
Supplementary Document |
Supporting Statement A |
Form HA-4632 Claimant's Medication - PDF/Paper Version
Addendum - 0289 (Final).docx
Claimant's Medication - PDF/Paper Version Claimant's Medication - PDF/Paper Version
Federal Enterprise Architecture: Income Security - General Retirement and Disability
| Form HA-4632 | Claimant's Medications | www.ssa.gov | Form |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.