Who needs an SSA Form 3441-BK?
A person seeking Social Security Disability (SSD) Benefits whose initial claim has been denied can still appeal the decision. In order to make an appeal, an SSD benefits applicant must submit their Disability Report — Appeal (viz. SSA Form 3441-BK). The form was created by the Social Security Administration to enable the applicants to appeal the refusal in SSD benefits and provide additional details and documents that might aid in the reconsideration process.
What is an SSA Form 3441-BK for?
The Disability Report — Appeal form allows the applicant to update the disability information provided in the initial claim that was denied.
Does an SSA Form 3441-BK require any accompaniment?
The Disability Report — Appeal form should be supported by one of the following attachments depending upon the case:
- Request for Reconsideration (SSA-561-U2),
- Request for Reconsideration-Disability Cessation (SSA-789),
- Request for Hearing by Administrative Law Judge (HA-501).
If there are any statements or documents that can serve as an evidence or confirmation of what is claimed on the form (e.g. medical records), they should be attached.
How do I fill out the Disability Report — Appeal form?
The properly completed form must provide the following details:
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Information about the disabled person (name, SSN, phone number and address)
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Contacts of people who can be addressed for reference (name, address and phone number)
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Medical conditions (how they changed since the initial claim)
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Medical treatment (how it changed)
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Information about the health care provider (filled out by the healthcare provider themselves)
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Other information about the medical condition of the disabled individual
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Activities
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Work and education
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Any remarks
Where do I send the completed SSA Disability Report — Appeal form?
The properly filled out form along with all the necessary attachments should be sent to the local Social Security Administration office.
