Claimant's Work Background

Form HA-4633 collects information needed in assessing an individual's disability within the meaning of the Social Security Act(the Act). SSA uses the information when an individual has requested a hearing before an administrative law judge (ALJ) on whether or not he or she is disabled. The completed HA-4633 provides an updated summary of the individual's relevant work history, which is information the ALJ requires in assessing the claimant's disability within the meaning of the Act. The respondents are claimants for disability benefits under Title II and/or Title XVI who have requested a hearing before an ALJ.

The latest form for Claimant's Work Background expires 2021-01-31 and can be found here.