DISABILITY REPORT - APPEAL - Form SSA-3441-BK
READ ALL OF THIS INFORMATION BEFORE YOU BEGIN COMPLETING THIS FORM We will use the information that you give us on this form to update your disability report information for your appeal. We will use the form to update your disability information since you last completed a disability report. Please complete as much of the form as you can. If you need help, your...
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Secretar y of State
Affirmati on of Correction
Secre tary of State
Vehicle Services Department
014 Howlett Bldg.
Springfie ld, IL 62756
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