Form preview

SSA-455-OCR-SM 2003 free printable template

Get Form
Place an X in only one box which best describes your health now as compared to BETTER Form SSA-455-OCR-SM 10-2003. Date of sure to use all four spaces. If you were hospitalized more than one month print last month you were hospitalized. Remarks Section Signature Date Form SSa-455-ocr-sm 02-2009 If you need more room to answer questions 1. Question 3 Can You Work Tell us if you have discussed with your doctor whether you can return to any kind of work and if so whether the doctor told you that...
pdfFiller is not affiliated with any government organization

Get, Create, Make and Sign SSA-455-OCR-SM

Edit
Edit your SSA-455-OCR-SM form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your SSA-455-OCR-SM form via URL. You can also download, print, or export forms to your preferred cloud storage service.

Editing SSA-455-OCR-SM online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
Here are the steps you need to follow to get started with our professional PDF editor:
1
Log in. Click Start Free Trial and create a profile if necessary.
2
Prepare a file. Use the Add New button. Then upload your file to the system from your device, importing it from internal mail, the cloud, or by adding its URL.
3
Edit SSA-455-OCR-SM. Text may be added and replaced, new objects can be included, pages can be rearranged, watermarks and page numbers can be added, and so on. When you're done editing, click Done and then go to the Documents tab to combine, divide, lock, or unlock the file.
4
Save your file. Select it from your list of records. Then, move your cursor to the right toolbar and choose one of the exporting options. You can save it in multiple formats, download it as a PDF, send it by email, or store it in the cloud, among other things.
pdfFiller makes dealing with documents a breeze. Create an account to find out!

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

SSA-455-OCR-SM Form Versions

Version
Form Popularity
Fillable & printabley
4.8 Satisfied (174 Votes)
4.2 Satisfied (122 Votes)
4.4 Satisfied (595 Votes)

How to fill out SSA-455-OCR-SM

Illustration

How to fill out SSA-455-OCR-SM

01
Obtain the SSA-455-OCR-SM form from the Social Security Administration (SSA) website or local office.
02
Write your full name, Social Security number, and address in the designated fields.
03
Indicate the purpose of the form, such as a continuing disability review, by following the instructions provided.
04
Provide details regarding your medical condition, including changes in treatment or ability since the last review.
05
List any employment or activities you have engaged in since your previous determination.
06
Answer all questions thoroughly and accurately to avoid delays in processing.
07
Review the form for completeness and correctness.
08
Sign and date the form before submission.
09
Send the completed form to the address provided in the instructions.

Who needs SSA-455-OCR-SM?

01
Individuals who are receiving Social Security disability benefits and are undergoing a continuing disability review.
02
Those who have been requested by the SSA to provide updated information about their medical condition or work status.

Who Needs Disability Update Report?

SSA must make sure that people who were once eligible to getting disability benefits are still qualified to receive them. Disability update report is created for people who are currently getting the payments.

What is Disability Update Report for?

With disability update report SSA reviews each particular disability case. SSA aims to make sure that a person who has once claimed to be disabled, still complies with disability rules and is qualified to get paid. The information provided by the person will be compared to the information given in the previous claim. This way SSA will decide whether additional medical investigation is required. Once particular case is reviewed, SSA may decide to stop the payments. A person in their turn can appeal the decision.

Is Disability Update Report Accompanied by Other Forms?

A person must provide medical reports and letters from doctors that prove their health condition.

When is Disability Update Report due?

Disability update report must be submitted to the SSA within 30 days from the moment it has been completed.

How Do I Fill out Disability Update Report?

It is very important that an applicant must contain accurate information. Therefore, all the questions are clear and easy to understand. If a person has difficulties answering the questions they must contact their authorized representative or social service representative. In total there are six questions. The answers must be provided in black ink. The form asks for the previous work activity, education, doctor’s decision about individual’s future work, current health condition, etc. the report must be signed, and dated. A person must also provide their telephone number.

Where Do I Send Disability Update Report?

The completed disability update report is sent to the SSA.

Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.4
Satisfied
595 Votes

People Also Ask about

We mail the Disability Update Report, or Form SSA-455, to disabled beneficiaries to obtain updated information about their medical conditions and recent treatments. You also have the option to complete the SSA-455 online.
Description of mailer form SSA-455 Disability Update Report. Form SSA-455 (Disability Update Report) is a self-help mailer form designed to solicit key information from a disabled beneficiary about his or her medical conditions and recent treatment for it.
Ten Tips and Tricks for Filling Out a Disability Update Report (SSA-455-BK) # 1 – Understand the Short Form. # 2 – Try Not to Get Too Stressed. # 3 – Make a Copy Before Starting. # 4 – Answer Honestly. # 5 – List Your Reason For Doctor's Visit. # 7 – Advanced trick: Look Up Your Profile Code.
Mailer Form SSA-455 Disability Update Report Form SSA-455 is a self-help mailer form designed to solicit key information from disabled beneficiaries about their medical conditions and recent treatment for same. "Recent" usually means within the last 2 years.
About the SSA-455 Form SSA-455: Disability Update Report is a form that collects information about SSI and SSDI beneficiaries' medical conditions, recent treatment for those conditions, recent education or training, and recent attempts to return to work. “Recent” typically means within the last two years.

Our user reviews speak for themselves

Read more or give pdfFiller a try to experience the benefits for yourself
5
Program is fantastic. Using it is simple, quick and has everything you need to complete a task. Just upload the PDF file and you are set to go.
Cathie C
4
Pros: +Has a send to sign feature +Allows editing of PDF text +Add/Remove/Edit Fillable fields +Save forms as templates +Up to 5 users with the largest subscription Cons: -Layout is not intuitive and hard to learn, even for the computer literate -Limits merging to 5 PDFs -Limits on file size (you can't work on large PDFs) -Other minor inconveniences that slow workflow I chose PDFfiller for my small company because for the same price as one user for Adobe's similar product, I can have 5 users for PDFfiller. It definitely has some limiting factors and can be frustrating but it's the best you can get for the price. Definitely worth the time to take the free trial and see how you like it.
Devin
4
Its good, limited but good. Not sure if ill continue subscription.
Jordan S
5
Works good so far. intuitive enough for me.
DWYoungPIA
5
Think it is a bit pricey-will definitely look at other options when my subscription is up or ask for a better price as I do like the service.
Sharon H
5
Very convenient the only thing I would like is to have different offers for a fax number. I barely use faxes and I would love to use this service. Can you have another fax payment offer?
Melanie S

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

SSA-455-OCR-SM and other documents can be changed, filled out, and signed right in your Gmail inbox. You can use pdfFiller's add-on to do this, as well as other things. When you go to Google Workspace, you can find pdfFiller for Gmail. You should use the time you spend dealing with your documents and eSignatures for more important things, like going to the gym or going to the dentist.
Yes, you can. With the pdfFiller mobile app for Android, you can edit, sign, and share SSA-455-OCR-SM on your mobile device from any location; only an internet connection is needed. Get the app and start to streamline your document workflow from anywhere.
Complete SSA-455-OCR-SM and other documents on your Android device with the pdfFiller app. The software allows you to modify information, eSign, annotate, and share files. You may view your papers from anywhere with an internet connection.
SSA-455-OCR-SM is a form used by the Social Security Administration (SSA) to assess if a person's medical condition continues to qualify them for disability benefits.
Individuals who are receiving Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) and are undergoing periodic review of their disability status are required to file SSA-455-OCR-SM.
To fill out SSA-455-OCR-SM, provide accurate personal information, answer questions about your current medical conditions and treatments, and disclose any changes in your ability to work.
The purpose of SSA-455-OCR-SM is to gather information necessary for the SSA to determine if a beneficiary's medical condition has improved and if they are still eligible for disability benefits.
The form requires reporting on current medical treatments, changes in health, employment status, and any new medical records or doctor's evaluations since the last review.
Fill out your SSA-455-OCR-SM online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview

Related Forms

If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.