Omb 0960 0292-2026

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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 and includes a privacy notice 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 the question regarding any recent medical treatment. If you have seen a doctor since the last update, select 'Yes' and list their names, addresses, and phone numbers along with the dates of treatment.
Next, describe what these doctors have communicated about your condition in the provided space.
If you have been hospitalized recently, indicate 'Yes' and provide the hospital's name and address. Include reasons for hospitalization and treatments received.
Review all entries for accuracy before submitting. If more space is needed, feel free to use additional sheets.

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