Form HA-4633
Claimants Work Background

Download form to fill out online.

What is Form HA-4633?

Form HA-4633 is known as Claimant’s Work Background. If you applied for Social Security Disability benefits and your application was denied, you’re entitled to an appeal. And one of the forms in any appeal is Form HA-4633.

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

Once you have submitted these two forms to indicate that you want to appeal, you will be asked to complete Form HA-4633.

If you’ve received a denial letter, don’t wait to file your appeal. You only have 65 days to request your hearing from the date you received your denial letter. If you miss the deadline to appeal, the Social Security Administration (SSA) most likely won’t accept your forms and you’ll have to start the process over.

What Information Do I Need to Complete Form HA-4633?

On Form HA-4633, you will be asked to list your employment history.

The form asks for approximate dates of employment, the name of your employers and their locations and the duties you performed.

In most appeals, you will need to provide work history for the 15 years prior to the onset of your disability.

In any disability case, it’s important you fill out forms such is this as honestly and as thoroughly as possible. The SSA wants to determine if you will be able to adjust to other types of work. For example, if you were a factory worker, they want to find out if you’re able to perform another job, say as a security guard.

To successfully win your disability case, you must prove that your medical conditions are so severe that you can’t work and that these conditions will prevent you from working any job.

Form HA-4633 is another form necessary to show a clear picture of your need for disability benefits. This form along with others regarding your medical history will be shown to the Administrative Law Judge (ALJ) who makes a decision on your case during your hearing.

Should I Get a Disability Lawyer to Help Me with Form HA-4633?

If your disability application was denied, we highly recommend you consult with an experienced disability attorney. The process to win disability benefits is complex. According to Social Security’s statistics, you have higher odds of winning your claim when you have representation.

Dealing with medical conditions that prevent you from working is difficult enough. Why make your life even more stressful keeping track of forms when an attorney can help you?

At Levine Benjamin, one of our experienced disability attorneys can help you with all the forms necessary to form your case and present it during your hearing. 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 your claim for disability benefits was denied, don’t wait to call us. Let us help you appeal your denial. If you’ve received a denial letter, call us right away. The sooner you call us, the quicker we can go to work on your appeal.

Contact our attorneys now 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