0960-0072 - SSA-454 - Continuing Disability Review Report

EDCS Screenshots of the SSA-454 (as of 05/23/2018)
Commented [I1]: In section Your Language Information
Under question “Can you speak and understand English”
and the sub questions:
-Add question” Can you read and understand English? YES
NO
-Add question: “Can you write more than your name in
English?” YES NO

454 About You

1

454 Contacts

2

454 Medical Conditions

3

454 Medical Sources

454 Tests

4

454 Medicines

454 Other Medical Information

5

Commented [I2]: Change “Have you received any
education since 04/04/2013?” to read “Have you received
any education since your last disability decision”?
Under this question add:
“If YES describe the education you received.”
Add lines to write in
Name of School
Telephone
Fax
Mailing Address
City, State, Province
Zip/Postal Code
Country (if not U.S.)
Type of Progam:
Dates of Attendance:
Date completed or scheduled to complete
Degree attained if any”
Under Job Training or Vocational School
Change question to read “Have you received any type of
specialized job, trade, or vocational training since your last
disability decision?

454 Education and Training

Under that add Checkbox with YES and Checkbox with NO
Under this add:
“If YES describe the education you received.”
Add lines to write in
Name of School
Telephone
Fax
Mailing Address
City, State, Province
Zip/Postal Code
Country (if not U.S.)
Type of Progam:
Dates of Attendance:
Date completed or scheduled to complete
Degree attained if any”

454 Voc Rehab/Employment

6

454 Daily Activities

7

454 Work

454 Remarks

8