OMB control number

Claimant's Medications

OMB 0960-0289 · SSA.

OMB 0960-0289

In cases where claimants request a hearing after denial of their disability claim for Social Security, SSA uses Form HA-4632 to request information from the claimant regarding the medications they use. This information helps the judge overseeing the case to fully investigate: (1) the claimant’s medical treatment and (2) the effects of the medications on the claimant’s medical impairments and functional capacity. The judge makes the completed form a part of the documentary evidence of record, placing it in the official record of the proceedings as an exhibit. The respondents are applicants (or their representatives) for OASDI benefits or SSI payments who request a hearing to contest an agency denial of their claim.

The latest form for Claimant's Medications expires 2028-07-31 and is listed under ICR 202407-0960-005.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form HA-4632 Claimant's Medication - PDF/Paper Version	Form
Addendum - 0289 (Final).docx	Supplementary Document
Supporting Statement - 0289 (Final).docx	Supporting Statement A
Claimant's Medication - PDF/Paper Version	Form
Claimant's Medications - ERE Internet Version	Other-Internet Screens

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202407-0960-005	Revision of a currently approved collection	2024-12-13
202111-0960-001	Revision of a currently approved collection	2021-11-02	Approved with change
201804-0960-005	Revision of a currently approved collection	2018-07-26	Approved with change
201502-0960-004	Revision of a currently approved collection	2015-06-02	Approved without change
201203-0960-008	Revision of a currently approved collection	2012-06-27	Approved without change
200902-0960-006	Revision of a currently approved collection	2009-06-15	Approved without change
200606-0960-016	Extension without change of a currently approved collection	2006-06-14	Approved without change
200305-0960-001	Extension without change of a currently approved collection	2003-05-02	Approved without change
200004-0960-003	Extension without change of a currently approved collection	2000-04-10	Approved without change
199909-0960-014	No material or nonsubstantive change to a currently approved collection	1999-09-23	Approved without change
199809-0960-014	No material or nonsubstantive change to a currently approved collection	1998-09-30	Approved without change
199703-0960-003	Extension without change of a currently approved collection	1997-03-14	Approved without change
199402-0960-004	Revision of a currently approved collection	1994-02-16	Approved without change
199101-0960-003	Revision of a currently approved collection	1991-01-10	Approved without change
199002-0960-001	Revision of a currently approved collection	1990-02-15	Approved without change
198908-0960-023	No material or nonsubstantive change to a currently approved collection	1989-08-25	Approved with change
198703-0960-006	Revision of a currently approved collection	1987-03-16	Approved without change
198511-0960-018	No material or nonsubstantive change to a currently approved collection	1985-11-01	Approved with change
198508-0960-051	No material or nonsubstantive change to a currently approved collection	1985-08-15	Approved with change
198403-0960-010	Revision of a currently approved collection	1984-03-26	Approved without change
198203-0960-010	New collection (Request for a new OMB Control Number)	1982-03-18	Approved without change

OMB Details

Claimant's Medication - PDF/Paper Version

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Information collection instruments
Form	Name	Electronic access	Type
Form HA-4632	Claimant's Medications	www.ssa.gov	Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.