Homeless Coalition of Polk County
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SSI/SSDI Forms



HA-501REQUEST FOR HEARING BY ADMINISTRATIVE LAW JUDGE
HA-550REQUEST FOR REVIEW OF HEARING DECISION/ORDER
SSA-561REQUEST FOR RECONSIDERATION
SSA-787PHYSICIAN'S/MEDICAL OFFICER'S STATEMENT OF PATIENT'S CAPABILITY TO MANAGE BENEFITS
SSA-827AUTHORIZATION TO DISCLOSE INFORMATION TO THE SOCIAL SECURITY ADMINISTRATION (SSA)
SSA-1696APPOINTMENT OF REPRESENTATIVE
SSA-3368DISABILITY REPORT - ADULT - Form SSA-3368-BK
SSA-3369WORK HISTORY REPORT-Form SSA-3369-BK