SSA 454BK PDF Template

[toc] After you file a successful disability claim with the Social Security Administration, they will occasionally use a medical review to determine whether you remain disabled. Generally, this occurs 3, 5, or 7 years after your initial decision. People are given either a long form or short form to update the SSA. The long form is referred to as the “Continuing Disability Review Report.” It is ten pages long.

The Social Security Administration will conduct periodic reviews and inquiries after a successful disability claim. The goal of these reviews is to make sure the individual is still disabled and meets the eligibility requirements for their disability payments. People who want to know when their next review will happen can call and ask, but the date the computer lists might be late by several months.

The length of the form can seem intimidating, but the questions are fairly straightforward. After you submit the form, you should call to make sure that the office received it. Your case will be assigned to a person. It’s helpful to get in contact with the case worker to find out whether they’ve received the right documentation. If there is documentation missing, you might have your disability claim denied.

This PDF form is one of two main forms that the SSA might ask you to complete when you’re under review. The short form is only two pages long. If they ask you to complete the long form, this is the one they’re referring to. It’s ten pages long.

You will need to fill out this form if you’re asked to by your SSA representative or local office.

The form should be used whenever the SSA needs it for a disability review. Most disability reviews are approved very quickly. However, you still have the ability to appeal if your review is not approved.

You should be aware of the deadline for the review, and be sure all of your paperwork is submitted before then.

If you don’t use the form when you’re required to do so, your disability review may be denied. You could have your disability payments revoked and be required to get a job.

Section 1 will require you to give information about the person in question, yourself. You’ll need to write your full name, Social Security number, and the daytime phone number at which you can be reached. There’s an optional box to fill in your email address.

If you have a relative or friend that can help your case, give their contact information. The SSA will contact them to ask about your level of disability. If you cannot understand English, fill out Box 1F with the contact information of someone who does speak English and can give you a message.

Make a note of both your height and weight when you aren’t wearing shoes. If you’re an adult, you should write out whatever disabling conditions have been limiting your ability to work. For people under the age of 18, you should write whatever disabling conditions are preventing you from participating in the same activities that other children in your age group do.

Note whether there has been any change in your condition since the date that your last disability decision was made. If you check YES, you’ll need to describe the specific changes you underwent and the dates at which these changes occurred.

Section 3 will gather information about your medical records. You’ll need to check whether you’ve been seeing a doctor about your condition or been to the hospital for it. You’ll also need to get the names and contact information of all of your doctors, therapists, and other medical professionals responsible for your care. You only need the ones who treated you within the last 12 months.

You’ll need to have information about any hospital or clinic you’ve visited within the last 12 months. If you had an inpatient stay, you’ll need to write the date in and date out. You’ll also need to note any treatments you received.

If any other institutions have information about your medical records within the last 12 months, you should give their names and contact information.

Section 4 will go over the medications you use. You’ll need to write the name of the medicine, the name of the doctor prescribing, any side effects you experience, and the reason for using the medicine.

If you received any medical tests for your illness within the last 12 months, you’ll need to write down the referring physician, the facility the test was completed at, and the date that the test was done. If there are tests scheduled for the future, write the date that the test will be done.

Section 6 should be completed if you’re at least 18 years of age. Check the highest school grade that you completed. If you’ve enrolled in any type of education since your last disability review, you should indicate so along with information about the school.

Section 7 will ask you to update your work information. Explain whether you’re working full time, part time, or not at all. Then give information about the jobs. Section 8 records any participation in support services of any kind. In Section 9, you’ll write information regarding the daily activities you partake in. This includes describing your typical day and answering a series of yes/no questions. “Yes” answers require an explanation.

In Section 10, you’l provide any additional remarks that are necessary.[pdf-embedder url=”https://cdn-prod-pdfsimpli-wpcontent.azureedge.net/pdfseoforms/pdf-20180219t134432z-001/pdf/ssa-454bk.pdf”]