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LexisNexis® Automated Social Security Forms

Publisher: Matthew Bender
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ISBN: 9780820547411
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Use the new LexisNexis® Automated Social Security Forms powered by HotDocs to quickly and easily prepare flawless court forms. This practice tool offers more than 100 fully-automated forms, including all relevant Social Security Administration forms and dozens of forms from NOSSCR’s Social Security Practice Guide.

The forms are intuitive, reliable, and easy-to-use. All you have to do is enter case or client-specific information once and it will be automatically inserted throughout the form where that information is relevant. Information entered on one form can be saved and used in other related forms. This means you’ll be printing out signature-ready forms in minutes.

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Featured Social Security Disability Titles

Purchase price includes free training.

Table of Contents

Topics Include:
  • Client Information and Representation

  •      New Case Information Form

         Daily Activities Questionnaire

         Daily Activities Questionnaire (Third Party Information)

         Exertional Daily Activities Questionnaire

         Pain Questionnaire

         Pain Questionnaire (Tennessee Disability Determination Section version)




  • Attorney's Fees

  •      Identifying Information for Possible Direct Payment of Authorized Fees (SSA-1695)

         Petition to Obtain Approval of a Fee for Representing a Claimant Before the SSA (SSA-1560-U4)

         Request for Appointed Representative's Direct Payment Information (SSA-1699)

         Request for Business Entity Taxpayer Information (SSA-1694)

         Sample Memorandum in Support of Motion for Attorney's Fees

         Sample Written Fee Agreement (For Use in the Fee Agreement Process)




  • Client Information and Representation

  •      Appointment of Representative (SSA-1696-U6)

         Sample Disability Interview Guide

         Sample Instruction Sheet for New Clients




  • Disability Determination

  •      Application for Disability Insurance Benefits (SSA-16-BK)

         Authorization for Source to Release Information to the SSA (SSA-827)

         Consent for Release of Information (SSA-3288)

         Disability Report-Adult (SSA-3368-BK)

         Disability Report--Appeal (SSA-3441-BK)

         Disability Report-Child (SSA-3820-BK)

         Medical and Job Worksheet - Adult (SSA-3381)

         Medical Report on Adult with Allegation of HIV Infection (SSA-4815-F5)

         Medical Report on Child with Allegation of HIV Infection (SSA-4815-F6)

         Medical Source Statement of Ability to Do Work-Related Activities (Physical) (HA-1151-BK)

         Mental Residual Functional Capacity Assessment (SSA-4734-F4-SUP)

         Questionnaire for Children Claiming SSI Benefits

         Request for Hearing by Administrative Law Judge (HA-501-U5)

         Request for Reconsideration (SSA-561-U2)

         Request for Review of Hearing Decision/Order (HA-520-U5)

         Residual Physical Functional Capacity Assessment (SSA-4734-BK)

         Sample Claimant/Physician Functional Capacity Report for HIV Condition

         Statement of Claimant or Other Person (SSA-795)

         Teacher Questionnaire (SSA-5665-BK)

         Work Activity Report--Employee (SSA-821-BK)

         Work Activity Report (Self-Employed Person) (SSA-820-BK)

         Work History Report (SSA-3369-BK)




  • Entitlements/Retirement Benefits

  •      Application for Retirement Insurance Benefits (SSA-1-BK)

         Request for Social Security Earnings Information (SSA-7050-F4)




  • Family Relationships

  •      Application for Child's Insurance Benefits (SSA-4-BK)

         Application for Widow's or Widower's Insurance Benefits (SSA-10-BK)

         Application for Wife's or Husband's Insurance Benefits (SSA-2-BK)

         Certificate of Support (SSA-760-F4)

         Statement of Marital Relationship (SSA-754-F4)

         Statement Regarding Marriage (SSA-753)




  • Hearings and Post-Hearings (Disability Adjudication Process)

  •      ALJ Bench Decision - Fully Favorable

         Claimant's Medications (HA-4632)

         Claimant's Medications (revised version without form number or date)

         Claimant's Recent Medical Treatment (HA-4631)

         Claimant's Recent Medical Treatment (revised version without form number or date)

         Claimant's Work Background (HA-4633)

         Report of Continuing Disability Interview (SSA-454-BK)

         Request for Withdrawal of Application (SSA-521)

         Sample Brief to the Appeals Council on Procedural Errors of ALJ

         Sample Hearing Questionnaire

         Sample Hearing Summary

         Sample Letter to Client After Receiving a Favorable Social Security Decision

         Sample Pre-Hearing Letter to ALJ

         Sample Pre-Hearing Summary for Advocate at Hearing

         Statement by the Representative

         Waiver of Written Notice of Hearing (HA-510)

         Waiver of Your Right to Personal Appearance Before an Adminstrative Law Judge (HA-4608)




  • Judicial Review

  •      Sample Complaint for Judicial Review

         Sample Issues with Discussion for Inclusion in Complaint




  • Medical/Vocational Evidence

  •      Authorization to Release Protected Health Information

         Employer Report of Special Wage Payments (SSA-131)

         Psychiatric Review Technique (SSA-2506-BK)

         Self-Employment/Corporate Office Questionaire (SSA-4184)

         Sample Checklist of Medical Impairment to Be Completed by Treating Physician

         Sample Employer's Assessment of the Functional Requirements of Claimant's Post Relevant Work

         Sample General Interrogatories to Physician

         Sample Letter to Employer for Obtaining Evidence Relating to Claimant's Employment

         Sample Letter to Physician Requesting Records

         Sample Medical Record Request From a Hospital

         Sample Objection to Consultative Evaluation Report for Failure to Perform Tests Under Listing

         Sample Physician's Physical Capacities Evaluation, Quick Form

         Sample Questions to Physician Formerly Used by the Administration to Gauge Work Capacity

         Sample Report of Physician Setting Out Diagnosis, History, Treatment, Functional Limitation




  • Medicare

  •      Claim for Amounts Due in the Case of a Deceased Beneficiary (SSA-1724)




  • Occupational Crosswalk for the Most Common Jobs

  •      Call-Out Operator - 237.367-014

         Cashier II - 211.462-010

         Charge-Account Clerk - 205.367-014

         Order Clerk - 249.362-026

         Order Clerk, Food and Beverage - 209.567-014

         Parking-Lot Attendant - 915.473-010

         Photocopying-Machine Operator - 207.685-014

         Storage-Facility Rental Clerk - 295.367-026

         Surveillance-System Monitor - 379.367-010




  • Payments

  •      Application to Proceed without Prepayment of Fees and Affidavit (AO 240)

         Request for Waiver of Overpayment Recovery or Change in Repayment Rate (SSA-632-BK)

         Sample Overpayment Questionnaire




  • Reopenings

  •      Sample Brief of Claimant's Request for Reconsideration of Deadline Extension




  • Representative Payees

  •      Request to Be Selected as Payee (SSA-11-BK)




  • Supplemental Security Income--Adult

  •      Application for Supplemental Security Income (SSA-8000-BK)

         Application for Supplemental Security Income (SSA-8001-BK)

         Authorization for SSA to Obtain Account Records from Financial Institutions (SSA-4641-U2)

         Authorization for the SSA to Obtain Personal Information (SSA-8510)

         Claimant's Statement About Loan of Food or Shelter (SSA-5062)

         Function Report - Adult (SSA-3373-BK)

         Function Report - Adult - Third Party (SSA-3380-BK)

         Living Arrangement/In-Kind Support and Maintenance Development Guide (SSA-8008)

         Notice to Representative of Claimant Before the SSA (SSA-L1697-U3)

         Plan for Achieving Self-Support (SSA-545-BK)

         Request for Reconsideration--Disability Cessation (SSA-789-U4)

         Sample Background Questionnaire for Determining Eligibility for Supp. Security Income

         Statement for Determining Continuing Eligibility for Supp. Security Income Payments (SSA-8203-BK)

         Statement of Income and Resources (SSA-8010-BK)

         Statement of Living Arrangements, In-Kind Support and Maintenance (SSA-8006-F4)




  • Supplemental Security Income--Child

  •      Childhood Disability Evaluation Form (SSA-538-F6)

         Function Report-Child-Birth to 1st Birthday (SSA-3375-BK)

         Function Report-Child-Age 1 to 3rd Birthday (SSA-3376-BK)

         Function Report-Child-Age 3 to 6th Birthday (SSA-3377-BK)

         Function Report-Child-Age 6 to 12th Birthday (SSA-3378-BK)

         Function Report-Child-Age 12 to 18th Birthday (SSA-3379-BK)

         Pain Report-Child (SSA-3371-BK)

         Questionnaire for Children Claiming SSI Benefits (SSA-3881-BK)

         Sample School Activities Questionnaire

         Sample Questionnaires Seeking Functional Information About Childhood Disabilities




  • Survivor's Benefits

  •      Claim for Amounts Due in the Case of a Deceased Beneficiary (SSA-1724)

         Notice Regarding Substitution of Party Upon Death of Claimant (HA-539)

         Reporting Changes That Affect Your Social Security Payment (SSA-1425)




  • Workers' Compensation Offset

  •      Offset Worksheet--Disability Insurance Benefits (SSA-2455)

         Request for Workers' Compensation/Public Disability Benefits Information (SSA-1709)

         Sample Social Security Disability Offset Worksheet

         Sample Disbursal Sheet

         Statement Regarding Inferred Death--Continued and Unexplained Absence (SSA-723-F4)

         Workers' Compensation/Public Disability Benefit Questionnaire (SSA-546)




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