Social security administration form ha 4631 2004-2026

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The document is a form from the Social Security Administration's Office of Hearings and Appeals, titled 'Claimant's Recent Medical Treatment.' It requires claimants to provide updated information about their medical treatment, including details of any doctors seen or hospitalizations since their last case update. The form emphasizes the importance of this information for determining eligibility for benefits under the Social Security Act and includes privacy notices regarding the use of the provided data.

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Click ‘Get Form’ to open it in the editor.
Begin by filling in your personal information, including your name and Social Security Number. If applicable, provide the wage earner's details as well.
In section B, answer whether you have been treated or examined by a doctor since the last update. If yes, list the names, addresses, and phone numbers of those doctors along with the dates of treatment.
Next, describe what these doctors have communicated regarding your condition in the provided space.
Indicate if you have been hospitalized since the last update. If yes, provide the hospital's name and address, along with reasons for hospitalization and treatments received.
If additional space is needed for any section, feel free to use extra sheets as necessary.

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Versions	Form popularity	Fillable & printable
2010	4.9 Satisfied (61 Votes)
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Who fills out SSA 1724?

Who needs form SSA-1724-F4? The IRS Form SSA-1724-F4 is used by the relatives of the deceased social security recipient or the legal representative of the estate. Among the immediate relatives allowed to receive these payments are the spouse, children, and parents of the deceased.

Can you apply for Social Security on the Internet?

Our online application is a convenient way to apply on your own schedule, without an appointment. You can also apply by phone or by appointment at a Social Security office.

How does SSA get notified of death?

In most cases, the funeral home will report the person's death to us. You should give the funeral home the deceased person's Social Security number if you want them to make the report. If you need to report a death or apply for benefits, call 1-800-772-1213 (TTY 1-800-325-0778).

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