Claimant's Medications - Form HA-4632

Introduction

When you have requested or are requesting a hearing before an Administrative law Judge (ALJ), use this form to tell us about the medications you take. To ensure that we have current medical information, you should also complete an HA-4631, Claimant's Recent Medical Treatment. If you have worked since you filed your application for disability benefits, complete an HA-4633, Claimant's Work Background.

How to Obtain the Form

Below you will find Form in Portable Document Format (PDF). To print the PDF version, you will need the Adobe Acrobat reader software. If you do not already have this special software, see our page on downloading and printing PDF documents.

After you download the Adobe Acrobat Reader, come back to this page and download the PDF version of the HA-4632:

Claimant's Medications, HA-4632

Where To Send The Form

Print the PDF HA-4632 form on 8 1/2 x 11 inch paper, complete the form, and mail it to the hearing office where your claim is located. The address and telephone number of the hearing office are on the letter acknowledging receipt of the request for hearing that we sent.


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