Form HA-4486
Claimants Statement When Request for Hearing is Filed and the Issue Is Disability

Download Form to fill it out online

What is Form HA-4486?

Form HA-4486 is known as Claimant’s Statement When Request for Hearing is Filed and the Issue is Disability. If you applied for Social Security Disability benefits and were denied, you have the right to appeal. And one of the first steps of any disability appeal is completing Form HA-4486.

To appeal your denial, you must complete Form HA-4486 and Form SSA-3441-BK (Disability Report – Appeal).

Once you receive your denial letter, it’s important you don’t hesitate to appeal. You usually have roughly 65 days to request your hearing from the date you receive your denial letter. If you wait too long, the Social Security Administration (SSA) may reject your forms and you will be forced to file a new application and start the process over from scratch.

What Information Do I Need to Complete Form HA-4486?

You will be asked if you have been able to work since your application was filed and if there have been any changes, improvements or worsening to your disability. You will also be asked how your daily activities have changed since you first filed your application and if you have received any additional medical treatment.

You will also have space to provide as much information about your case and medical condition(s) as possible. This is your chance to outline your case so don’t let it go to waste.

No matter where you are in the disability process, it’s important you keep medical records to help boost your case. When you go to your hearing, your medical evidence and work history are key components of your case.

Should I Get a Disability Attorney to Help Me with Form HA-4486?

If your disability claim was denied, we recommend you contact a disability attorney. The disability process is complex and per Social Security’s statistics, you have a better chance to win your claim when you have representation.

At Levine Benjamin, one of our experienced disability attorneys can help you with all the forms necessary to get your hearing scheduled. We can also help you gather your medical evidence, prepare you for your hearing and present a clear case to the judge to give you the best chance to win benefits.

If you were denied and want to appeal your disability claim, don’t wait to call us. The sooner you get us involved, the faster we can get to work on your case.

Whether you need to apply or if you’re appealing a denial, contact our office today to schedule a FREE consultation of your disability claim.


Disability Report-Adult

Work History Report

Claimant's Statement when 'Request for Hearing' is filed and issue is Disability

Disability Report Appeal

Recent Medical Treatment

Medication List

Recent Work History