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SSA appeal packet

The five SSA forms an appeal commonly needs, prepared from one set of answers.

Related journey: open the full journey. NOLO does not fill or submit forms — this prepares your answers so you write them once instead of five times.

Fill this once

These answers appear on every form below that asks for them.

What NOLO does: these answers are held in this page while you use it. NOLO does not save them, does not send them to a server, and keeps no copy — there is no request that carries them.

What NOLO cannot control: your browser may keep autofill entries, form history, or a cached copy of this page; printing may leave the packet in a print queue or spool file; and a saved PDF stays wherever it was saved. On a shared or work computer, clear the answers when you are done and collect anything you print.

Full legal nameAs it appears on the Social Security record or official notice.

Date of birthWritten the way the form asks — usually MM/DD/YYYY.

Place of birthCity and state, or country if outside the United States.

Mailing addressWhere official mail can actually be received and picked up.

PhoneA number that reaches the person, or a safe message number.

NOLO never asks for these

They print as blank lines for you to write on the agency’s own form. Do not type them here or anywhere that is not the agency.

Social Security number — Required on most SSA forms. Never type this into NOLO or any website that is not the agency's own.
Claim or notice number — Copy from the dated notice itself; the notice controls the stage and the deadline.
Date on the notice — The appeal window runs from this date. Confirm it against the paper notice.

0 of 5 answered · 5 forms below

SSA appeal packet

The dated notice controls which stage applies and when the deadline falls. Reconsideration and hearing are different stages: sending the wrong one does not preserve an appeal. NOLO does not confirm a deadline, a stage, or an outcome.

Write these on every form by hand

Social Security number

Claim or notice number

Date on the notice

Request for Reconsideration

SSA-561-U2

Social Security Administration · source checked 2026-08-06

Asks SSA to reconsider a decision, when the notice directs reconsideration.

Name of claimant: —
Date of birth: —
Mailing address: —
Phone: —

This form also asks for

What you disagree with, in the claimant's words

Date of the determination being appealed

Disability Report — Appeal

SSA-3441-BK

Social Security Administration · source checked 2026-08-28

Updates medical and work information for the appeal.

Full legal name: —
Date of birth: —
Mailing address: —
Phone: —

This form also asks for

Other names used, including maiden or former names

Email address, if the form asks for one and there is a reliable one

Treating providers, facilities, and dates since the last report

Medications and who prescribes them

Work attempted since the last report

Authorization to Disclose Information to the Social Security Administration

SSA-827

Social Security Administration · source checked 2026-08-05

Authorises release of records to SSA.

Name of subject of record: —
Date of birth: —
Place of birth: —

This form also asks for

Signature and date — the official form requires both

Claimant’s Appointment of a Representative

SSA-1696

Social Security Administration · source checked 2026-08-05

Records the appointment of a representative, when there is one.

Claimant name: —
Date of birth: —
Mailing address: —
Phone: —

This form also asks for

Representative name, firm, and contact details

Both claimant and representative signatures are required

Request for Hearing by Administrative Law Judge

HA-501

Social Security Administration · source checked 2026-08-06

Requests a hearing before an administrative law judge, after reconsideration.

Claimant name: —
Date of birth: —
Mailing address: —
Phone: —

This form also asks for

Date of the reconsideration determination

Whether an interpreter is needed, and the language

NOLO does not fill, submit, or file any of these forms, and preparing answers does not establish eligibility, acceptance, a deadline, or an outcome. Confirm the current edition on the agency’s own page before submitting — an edition can change after the date shown above.

This printout carries real details about a person. Collect every page from the printer, keep it with the client file, and shred anything you do not hand over. Printing or saving a PDF can leave a copy in a print queue, a spool file, or a downloads folder that NOLO cannot reach or clear.

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SSA appeal packet

The five SSA forms an appeal commonly needs, prepared from one set of answers.

Related journey: open the full journey. NOLO does not fill or submit forms — this prepares your answers so you write them once instead of five times.

Fill this once

These answers appear on every form below that asks for them.

What NOLO does: these answers are held in this page while you use it. NOLO does not save them, does not send them to a server, and keeps no copy — there is no request that carries them.

Full legal nameAs it appears on the Social Security record or official notice.

Date of birthWritten the way the form asks — usually MM/DD/YYYY.

Place of birthCity and state, or country if outside the United States.

Mailing addressWhere official mail can actually be received and picked up.

PhoneA number that reaches the person, or a safe message number.

NOLO never asks for these

They print as blank lines for you to write on the agency’s own form. Do not type them here or anywhere that is not the agency.

Social Security number — Required on most SSA forms. Never type this into NOLO or any website that is not the agency's own.
Claim or notice number — Copy from the dated notice itself; the notice controls the stage and the deadline.
Date on the notice — The appeal window runs from this date. Confirm it against the paper notice.

0 of 5 answered · 5 forms below

SSA appeal packet

Write these on every form by hand

Social Security number

Claim or notice number

Date on the notice

Request for Reconsideration

SSA-561-U2

Social Security Administration · source checked 2026-08-06

Asks SSA to reconsider a decision, when the notice directs reconsideration.

Name of claimant: —
Date of birth: —
Mailing address: —
Phone: —

This form also asks for

What you disagree with, in the claimant's words

Date of the determination being appealed

Disability Report — Appeal

SSA-3441-BK

Social Security Administration · source checked 2026-08-28

Updates medical and work information for the appeal.

Full legal name: —
Date of birth: —
Mailing address: —
Phone: —

This form also asks for

Other names used, including maiden or former names

Email address, if the form asks for one and there is a reliable one

Treating providers, facilities, and dates since the last report

Medications and who prescribes them

Work attempted since the last report

Authorization to Disclose Information to the Social Security Administration

SSA-827

Social Security Administration · source checked 2026-08-05

Authorises release of records to SSA.

Name of subject of record: —
Date of birth: —
Place of birth: —

This form also asks for

Signature and date — the official form requires both

Claimant’s Appointment of a Representative

SSA-1696

Social Security Administration · source checked 2026-08-05

Records the appointment of a representative, when there is one.

Claimant name: —
Date of birth: —
Mailing address: —
Phone: —

This form also asks for

Representative name, firm, and contact details

Both claimant and representative signatures are required

Request for Hearing by Administrative Law Judge

HA-501

Social Security Administration · source checked 2026-08-06

Requests a hearing before an administrative law judge, after reconsideration.

Claimant name: —
Date of birth: —
Mailing address: —
Phone: —

This form also asks for

Date of the reconsideration determination

Whether an interpreter is needed, and the language