Yes, you can fill out Form HA-4633 yourself, and doing it carefully can make the difference between winning and losing your Social Security disability hearing. The form, officially titled Claimant’s Recent Medical Treatment, is the Social Security Administration’s way of forcing you to update the record before your Administrative Law Judge (ALJ) hearing so the judge has every doctor visit, hospital stay, and medication change in front of them. Miss a provider, leave a date blank, or submit it late, and you risk an unfavorable decision under the agency’s strict 5-day evidence rule found at 20 CFR § 404.935.
The form is short, just one page, but the stakes are enormous. According to the SSA’s FY 2025 Annual Performance Report, only about 49% of hearing-level claims end in a fully favorable decision, and incomplete medical records are one of the top reasons judges deny benefits. The agency’s own HALLEX I-2-6-58 instructs ALJs to use HA-4633 to confirm the record is complete, which means the form is not a formality, it is evidence.
Here is what you will learn in this guide:
- 📋 The exact line-by-line method to complete every field on HA-4633 without triggering a development delay
- ⚖️ How federal regulations like 20 CFR § 404.1512 and the 5-day rule control your duty to disclose treatment
- 🏥 Three real-world scenarios with named claimants showing exactly what to write for back pain, depression, and post-stroke recovery
- 🚫 The seven most common mistakes that get claims denied or remanded, and how to dodge each one
- 💡 State-by-state nuances at the DDS level, plus how the Appeals Council and federal courts treat HA-4633 omissions
What Form HA-4633 Is and Why It Exists
Form HA-4633, Claimant’s Recent Medical Treatment, is a one-page Office of Hearings Operations (OHO) document that the SSA mails out roughly 75 days before your scheduled ALJ hearing. The form’s job is to capture every medical provider you have seen, every medication you take, and every test you have had since your last evidence submission. Its OMB control number is 0960-0292, which means it is approved under the Paperwork Reduction Act and is mandatory once the agency requests it.
The agency created HA-4633 because disability hearings are de novo, meaning the ALJ looks at your case fresh and is not bound by what the state Disability Determination Services (DDS) decided earlier. Without an updated treatment list, the judge cannot satisfy the duty to develop a complete record, a duty rooted in Sims v. Apfel, 530 U.S. 103 (2000) and reinforced by HALLEX I-2-5-13. The consequence of a thin record is brutal, the ALJ can deny your claim simply because you did not prove disability, even if you really are disabled.
A common misconception is that the SSA will pull all your records automatically. That is false. The agency only requests records from providers you list, and federal courts including the Eighth Circuit in Snead v. Barnhart have held that claimants share the burden of identifying treatment sources. If you forget your pain management clinic, the judge will never see those injection notes.
The form is different from the SSA-3441 (Disability Report – Appeal) and the SSA-827 (Medical Release). HA-4633 is purely an update tool used at the hearing level, while the SSA-3441 is used between the initial denial and reconsideration, and the SSA-827 authorizes release of records from any provider you name. You will likely sign all three at different stages, and each one feeds the others.
The Statutory and Regulatory Backbone
The duty to provide evidence comes from Section 223(d)(5)(A) of the Social Security Act, which says the claimant must furnish medical and other evidence of disability. This statute is operationalized in 20 CFR § 404.1512 for Title II claims and 20 CFR § 416.912 for Title XVI (SSI) claims. The plain-English version is simple, you must tell the SSA about every medical source that has evaluated, examined, or treated you for the conditions you allege.
The consequence of ignoring this duty is more than a delay. Under the 5-day rule at 20 CFR § 404.935(a), evidence must be submitted or identified at least five business days before the hearing. If you miss the deadline without one of the narrow good-cause exceptions, the ALJ will refuse the evidence. That refusal can be the difference between a favorable on-the-record decision and a denial.
A real-world example helps. Imagine Maria, a 54-year-old former hotel housekeeper with degenerative disc disease. She lists her primary care doctor on HA-4633 but forgets the orthopedic surgeon who ordered her recent MRI. The ALJ never sees the MRI, finds her capable of light work, and denies her claim. If Maria had listed the surgeon, the MRI would have triggered Listing 1.15 analysis and likely a fully favorable decision.
A common misconception is that you can fix this on appeal. The Appeals Council only considers new evidence under the strict Mathews v. Eldridge materiality standard codified at 20 CFR § 404.970, and the Supreme Court’s decision in Biestek v. Berryhill, 587 U.S. ___ (2019) makes it clear that substantial-evidence review is deferential to the ALJ. Fixing it later is hard, expensive, and often impossible.
When and How You Receive HA-4633
The Office of Hearings Operations mails HA-4633 along with the hearing acknowledgment letter, usually 60 to 90 days before your hearing date. You can also download a blank copy from the SSA forms page at any time. Many representatives proactively complete it during case preparation rather than waiting for the mailing.
You return the completed form by mail to the hearing office address printed on the cover letter, by fax, or by uploading it through the Electronic Records Express (ERE) portal if you have a representative with access. The agency’s preferred method in 2026 is ERE because it timestamps the submission, which is critical for the 5-day rule.
The consequence of late submission depends on the reason. The regulation lists three good-cause exceptions, agency action that misled you, a physical/mental/educational/linguistic limitation, or some other unusual unexpected or unavoidable circumstance beyond your control. If none applies, the ALJ can exclude the evidence entirely.
A real-world example is James, a 47-year-old veteran with PTSD. He receives HA-4633 but his symptoms keep him from opening mail for weeks. He submits the form three days before the hearing. Because PTSD is a documented mental limitation, the ALJ accepts a good-cause showing under 20 CFR § 404.935(b)(2) and the evidence comes in.
A common misconception is that hiring a lawyer late means you automatically get more time. That is not true. The Eleventh Circuit in Walker v. Commissioner and other courts have upheld ALJ refusals to extend the 5-day rule simply because counsel appeared at the last minute.
A Line-by-Line Walkthrough of Every Field
Below is every line on Form HA-4633, what it asks, why it matters, and what to write. Treat each line as a small legal declaration, because the form is signed under penalty of perjury per the SSA’s general perjury warning at Section 208 of the Act.
Field 1: Claimant’s Name and Social Security Number
This field anchors the form to your file. Write your name exactly as it appears on your Social Security card, last name first. Use your full nine-digit SSN, no dashes are required but they are allowed.
The consequence of a mismatched name is administrative. If you got married and your card still says Maria Garcia but you write Maria Lopez, the form may be filed in the wrong eFolder, delaying your hearing. A real-world example is Aisha Patel-Brown, who hyphenated her name after marriage but had not updated her card. Her form sat unmatched for three weeks until her representative called the hearing office.
A common misconception is that the SSN field is optional. It is not. Without the SSN the OHO cannot route the form, and HALLEX I-2-1-15 requires the eFolder to be properly identified.
Field 2: Have You Seen a Doctor or Other Medical Source Since (Date)?
The form prints a date, usually the date of your last evidence submission or your reconsideration denial. You check Yes or No.
If you check No and you actually have seen a provider, you have made a false statement on a federal form. The consequence can include criminal liability under 18 U.S.C. § 1001, though prosecutions are rare, plus an adverse credibility finding that can sink your case under SSR 16-3p.
A real-world example is David, a 39-year-old with Crohn’s disease, who checked No to avoid filling out the rest of the form. The ALJ later subpoenaed his pharmacy records, saw active Humira prescriptions, and issued an unfavorable decision citing inconsistent statements.
A common misconception is that minor visits like a flu shot don’t count. They do, because SSR 96-8p requires the ALJ to consider all medically determinable impairments, even non-severe ones, when assessing residual functional capacity (RFC).
Field 3: Provider Name, Address, Phone, and Treatment Dates
This is the heart of the form. For each provider, list the full clinic or doctor name, the complete street address, a working phone number, and the dates of every visit since the cutoff date.
The consequence of incomplete provider information is that the SSA will not be able to request records, and the ALJ may decide your case without them. Per 20 CFR § 404.1520b(c), the agency may make a decision based on the evidence available if you do not respond to development requests.
A real-world example is Linda, a 62-year-old with rheumatoid arthritis. She wrote Dr. Smith, downtown with no address. The hearing office could not locate the records, the joint imaging never made it into the file, and the ALJ found her capable of sedentary work despite her actual functional limits.
A common misconception is that listing the hospital is enough. It is not. Hospitals have separate departments, ER, inpatient, outpatient surgery, physical therapy, and each may have a different records custodian. List the specific department or clinic.
Field 4: Reason for Treatment
State the condition treated, not the symptom alone. Write lumbar radiculopathy rather than back hurts, and major depressive disorder, recurrent, severe rather than sad.
The consequence of vague reasons is that the ALJ may not connect the visit to your alleged impairments. The judge follows the five-step sequential evaluation in 20 CFR § 404.1520, and a visit that is not tied to a medically determinable impairment is largely ignored at step two.
A real-world example is Carlos, a 51-year-old former roofer, who wrote checkup for every visit. The ALJ assumed routine wellness care and missed the fact that each visit included a knee injection for severe osteoarthritis.
A common misconception is that you should hide unrelated conditions. You should not. Under SSR 02-1p and the combined-effects rule at 20 CFR § 404.1523, the ALJ must consider the combined effect of all impairments, severe or not.
Field 5: Medications
List every prescription and over-the-counter drug, including dosage, frequency, and the prescribing doctor. Do not forget supplements like CBD or melatonin if a doctor recommended them.
The consequence of an incomplete medication list is twofold. First, the ALJ may underestimate the severity of your conditions because heavy medication regimens corroborate pain and limitation. Second, side effects like drowsiness from gabapentin can independently support an RFC for less than sedentary work, but only if they are documented.
A real-world example is Beth, a 44-year-old with fibromyalgia. She listed only Tylenol but actually took Lyrica, Cymbalta, and Flexeril. After her representative amended the form, the ALJ found that combined sedating side effects precluded full-time work.
A common misconception is that listing medications hurts you because they show your conditions are controlled. The opposite is usually true. Under SSR 16-3p, aggressive medication regimens are evidence of symptom severity.
Field 6: Tests and Procedures
List every imaging study, lab, biopsy, EMG, EEG, pulmonary function test, and surgery since the cutoff date. Include the date, the body part, and the facility.
The consequence of omitting tests is that listing-level evidence can disappear. Many medical listings, like Listing 1.15 for spinal disorders or Listing 14.09 for inflammatory arthritis, require specific imaging or lab findings.
A real-world example is Ravi, a 58-year-old with chronic kidney disease. He forgot to list his most recent eGFR lab. The ALJ found his CKD non-severe at step two. After remand, the lab showed an eGFR of 19, which met Listing 6.05 and produced a fully favorable decision.
A common misconception is that negative tests should be hidden. They should not, because negative tests can still support credibility and rule out competing diagnoses, which is how SSR 96-7p (now superseded by SSR 16-3p) framed symptom evaluation.
Field 7: Hospitalizations and Emergency Room Visits
List every inpatient stay and every ER visit. Include admission and discharge dates and the chief complaint.
The consequence of skipping ER visits is that acute exacerbations, which often prove ongoing severity, vanish from the record. Under SSR 19-4p on primary headache disorders, for example, ER visits are key evidence of frequency and intensity.
A real-world example is Tomas, a 36-year-old with chronic migraines. He had eight ER visits in 12 months but listed none. The ALJ found his headaches non-severe. On appeal the visits were added, and the case was remanded.
A common misconception is that urgent care doesn’t count as an ER visit. It does count as treatment and must be listed under Field 3 even if it is not technically an emergency department visit.
Field 8: Signature, Date, and Phone
Sign in ink or with a valid e-signature, date the form, and provide a daytime phone number. Per HALLEX I-2-1-30, an unsigned form is not evidence.
The consequence of an unsigned form is that the OHO will return it, eating into your 5-day window. A real-world example is Helen, who mailed the form on day six, unsigned, and lost the ability to submit two months of mental health records.
A common misconception is that your representative can sign for you. They cannot sign Field 8 because the certification is yours, though they can prepare the form for your review and signature.
Three Scenarios With Named Claimants
The next three tables show how a real claimant should approach HA-4633 for the most common impairment categories at hearing. Each scenario is built from typical SSA Listing of Impairments fact patterns.
Scenario 1: Maria, Degenerative Disc Disease
| Claimant Action | Outcome at Hearing |
|---|---|
| Maria lists her PCP, orthopedic surgeon, pain management clinic, and physical therapist with full addresses | ALJ pulls all records, sees recent MRI showing nerve root compromise, finds Listing 1.15 met |
| Maria lists every medication, including Oxycodone 10mg q6h, Gabapentin 600mg TID, and Cyclobenzaprine 10mg HS | ALJ accepts that sedation and pain preclude sustained work activity under SSR 96-8p |
| Maria forgets her epidural steroid injection on March 4, 2026 | ALJ misses key evidence of failed conservative care, finds RFC for light work, denies claim |
Scenario 2: David, Major Depressive Disorder
| Claimant Action | Outcome at Hearing |
|---|---|
| David lists his psychiatrist, therapist, IOP program, and crisis hospitalization with exact dates | ALJ finds marked limitations in two of the four Paragraph B areas, meets Listing 12.04 |
| David includes Sertraline, Bupropion, Lamotrigine, and Trazodone with prescriber names | ALJ corroborates severity through aggressive polypharmacy regimen |
| David checks No on Field 2 because he feels embarrassed about the hospitalization | ALJ later discovers the inpatient stay, finds adverse credibility under SSR 16-3p, denies claim |
Scenario 3: Linda, Post-Stroke Recovery
| Claimant Action | Outcome at Hearing |
|---|---|
| Linda lists neurology, occupational therapy, speech therapy, and home health with treatment dates | ALJ tracks neurological deficits over the 12-month durational period required by 20 CFR § 404.1509 |
| Linda lists her recent neuropsychological evaluation showing processing speed in the 4th percentile | ALJ uses results to support a less-than-sedentary RFC and finds her disabled at step five |
| Linda lists her primary care doctor only, omits neurology and OT | ALJ has insufficient evidence of ongoing deficits, applies the medical-vocational Grid Rule 201.14, denies claim |
Mistakes to Avoid
The following are the most common HA-4633 errors and the negative outcomes they cause. Each is drawn from published Appeals Council remand orders and federal court reversals.
- Listing only the primary care doctor. Specialists drive most disability findings, and omitting them leaves the strongest evidence out of the file.
- Writing same as before instead of full provider details. The OHO records request system requires a fresh address each time, and shortcuts trigger development delays that push the hearing.
- Forgetting urgent care and walk-in clinics. These visits often document acute flares that prove the longitudinal severity required by 20 CFR § 404.1509.
- Skipping over-the-counter medications and supplements. Items like high-dose ibuprofen or melatonin signal symptom severity and corroborate pain or sleep impairment.
- Submitting the form on day four instead of day six. The 5-day rule counts business days, not calendar days, and miscounting weekends can trigger exclusion under 20 CFR § 404.935.
- Using nicknames or partial addresses for clinics. Records custodians cannot match incomplete identifiers, and the SSA’s records request unit will simply mark the source as unobtainable.
- Not telling your representative when you complete the form. Duplicate or conflicting forms in the eFolder confuse the ALJ and can produce inconsistent statement findings under SSR 16-3p.
- Hiding mental health treatment. Under Listing 12.00, mental impairments often combine with physical ones to meet a listing or reduce RFC, and hiding them forfeits that argument.
- Failing to update the form for visits between submission and hearing. Per HALLEX I-2-6-58, you have a continuing duty to disclose, and the ALJ will ask at the hearing.
Examples of Properly Completed Fields
The examples below show what well-drafted answers look like. Each is a fictional but realistic snapshot.
Example A: Aisha Patel-Brown, Lupus
Aisha is 41 and worked as a paralegal until SLE forced her to stop. On Field 3 she writes, Dr. Priya Nair, Mountain West Rheumatology, 1450 E Williams St, Suite 300, Tucson, AZ 85719, (520) 555-0114, visits 1/8/2026, 2/12/2026, 3/19/2026, 4/22/2026. On Field 4 she writes Systemic Lupus Erythematosus with lupus nephritis. She lists Hydroxychloroquine 400mg daily, Mycophenolate 1g BID, and Prednisone 10mg daily.
Example B: Tomas Reyes, Chronic Migraines
Tomas is 36 and a former delivery driver. On Field 7 he writes, Banner University Medical Center ER, 1625 N Campbell Ave, Tucson, AZ 85724, ER visits on 11/4/2025, 12/19/2025, 1/22/2026, 2/9/2026, 3/14/2026, 4/2/2026, 4/29/2026, 5/8/2026, all for status migrainosus. He lists Erenumab 140mg monthly, Sumatriptan 100mg PRN, and Topiramate 100mg BID.
Example C: Beth Okafor, Fibromyalgia and Depression
Beth is 44 and a former teacher. On Field 5 she writes, Pregabalin 150mg BID (Dr. Chen), Duloxetine 60mg daily (Dr. Patel), Cyclobenzaprine 10mg HS (Dr. Chen), Trazodone 100mg HS (Dr. Patel). On Field 6 she lists Tender point exam 2/3/2026, MRI cervical spine 3/15/2026, PHQ-9 score 22 on 4/10/2026.
Do’s and Don’ts
The following actionable rules come straight from POMS DI 20505.001 and HALLEX guidance.
- Do download a fresh copy of HA-4633 from ssa.gov rather than reusing an old one, because field numbering can change between OMB renewals.
- Do keep a personal medical timeline so you can answer the form in 30 minutes instead of 30 days.
- Do submit through Electronic Records Express when possible, because the timestamp protects you under the 5-day rule.
- Do update your representative the same day you mail the form so they can supplement with records they already hold.
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Do keep a copy with the date and method of submission, certified mail receipts are gold at later appeals.
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Don’t check No on Field 2 unless it is literally true, because it triggers credibility scrutiny under SSR 16-3p.
- Don’t lump multiple providers together on one line, each provider needs its own complete entry.
- Don’t wait for the 75-day mailing if you already know about new treatment, submit a Form HA-4632 request for issues sooner.
- Don’t use abbreviations that the records custodian will not understand, write Phoenix VA Health Care System not VA.
- Don’t sign and date with a future date, because it will be rejected under HALLEX I-2-1-30.
Pros and Cons of Completing HA-4633 Yourself
There are real tradeoffs between filling out HA-4633 alone and using a representative.
- Pro: You save the time of explaining your medical history to a stranger, since you know your providers best.
- Pro: You avoid the slight delay of mailing or faxing the form to your representative for completion.
- Pro: The cost is zero, while attorney fees on Title II cases are capped at 25% of past-due benefits or $9,200 in 2026 under SSA’s fee-cap rule.
- Pro: You build familiarity with your own record, which helps you testify clearly at the hearing.
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Pro: You control timing, which can be helpful when you want to lock in the 5-day deadline early.
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Con: You may miss legal nuances, like the importance of listing pharmacy records or third-party caregivers, that an experienced advocate would catch.
- Con: You may underuse Electronic Records Express, which most pro se claimants cannot access without help.
- Con: You bear sole responsibility for accuracy, and a mistake on Field 2 can be used against you under SSR 16-3p.
- Con: You may not know how to invoke good-cause exceptions under 20 CFR § 404.935(b) if you are late.
- Con: You miss the strategic benefit of letting counsel pair HA-4633 with a pre-hearing brief that frames the medical evidence.
State and Federal Nuances
Even though Social Security disability is a federal program, state Disability Determination Services agencies vary in how aggressively they request records. In states like California and New York, DDS often pulls electronic records directly from large hospital systems through HIPAA-compliant data exchanges, which means HA-4633 omissions are sometimes caught earlier. In states with smaller DDS offices like Wyoming, Vermont, and South Dakota, the burden falls more heavily on the claimant.
The consequence of state variation is that two claimants with identical medical conditions can have very different evidentiary records at the hearing level. Federal courts have recognized this asymmetry, and the Ninth Circuit in Tonapetyan v. Halter reinforced the ALJ’s independent duty to develop the record when a claimant is unrepresented.
A common misconception is that the federal courts can fix a thin record on appeal. They cannot, because federal review under 42 U.S.C. § 405(g) is limited to the administrative record. New evidence requires a sentence-six remand, which courts grant rarely.
A real-world example is Ravi, our CKD claimant from earlier. His DDS in Texas did not pull his nephrology labs because the clinic was not in their data-share network. Only because he listed the clinic on HA-4633 did the ALJ obtain the records that proved Listing 6.05.
How HA-4633 Interacts With the Appeals Council and Federal Court
After the ALJ issues a decision, you have 60 days to ask the Appeals Council to review under 20 CFR § 404.967. The Council looks at whether the ALJ followed agency policy, including whether HA-4633 was used to develop the record under HALLEX I-2-6-58.
The consequence of an HA-4633 failure at the Council level depends on who failed. If you failed to list a provider, the Council typically denies review. If the ALJ failed to send HA-4633 or ignored a properly completed one, the Council often remands.
A real-world example is Carlos, our former roofer. The ALJ never mailed HA-4633 because the hearing office was understaffed. The Council found a procedural error under HALLEX I-3-3-4 and remanded for a new hearing. Sims v. Apfel protects this kind of issue exhaustion, since exhaustion is not required for Appeals Council issues.
A common misconception is that federal court is the place to introduce new evidence. It is not. Under Melkonyan v. Sullivan, 501 U.S. 89 (1991), sentence-six remands require both materiality and good cause for the prior omission, a high bar most claimants cannot meet.
Key Entities Involved With HA-4633
The form sits at the intersection of multiple SSA components and outside parties. The Office of Hearings Operations (OHO) sends and receives the form. The ALJ uses it at the hearing and during decision-writing. The hearing office support staff request records from the providers you list.
State DDS agencies remain peripheral at the hearing level but their earlier requests inform what is already in the file. Outside parties include your treating providers, who must respond to record requests under HIPAA’s permitted disclosures rule, and your representative, who often coordinates submission.
The consequence of misunderstanding these roles is wasted time. A real-world example is Helen, who called the DDS examiner three times asking about her hearing-level records. DDS no longer had her file, and her hearing was delayed two months while she figured out who to call.
A common misconception is that the ALJ personally requests records. They do not. ALJs decide cases, while hearing office staff handle records development under HALLEX I-2-5-13.
Recap of Key Court Rulings
Several decisions shape how HA-4633 is used and reviewed. Sims v. Apfel holds that issue exhaustion is not required at the Appeals Council, which protects pro se claimants who do not raise HA-4633 errors. Biestek v. Berryhill confirms substantial-evidence review is deferential, which makes a complete HA-4633 critical at the ALJ stage rather than later.
Tonapetyan v. Halter imposes a duty on ALJs to develop the record for unrepresented claimants, which often means actively reviewing HA-4633 with the claimant on the record. Smith v. Berryhill, 587 U.S. ___ (2019) confirms that Appeals Council dismissals are judicially reviewable, opening the door to challenge HA-4633-related procedural errors.
The consequence of these rulings is that HA-4633 is not a simple administrative form, it is a piece of the constitutional due process architecture that lets disability claimants present their case. A real-world example is Beth, whose representative cited Tonapetyan to obtain a remand when the ALJ failed to clarify ambiguous medication entries on HA-4633.
A common misconception is that older cases like Richardson v. Perales, 402 U.S. 389 (1971) are no longer relevant. They remain foundational, because Perales established that hearsay medical evidence, like the records HA-4633 captures, can constitute substantial evidence.
FAQs
Is Form HA-4633 mandatory?
Yes. Once OHO mails it, you must complete and return it. Failure to respond can lead the ALJ to decide the case on the existing record under 20 CFR § 404.1520b(c).
Can my representative complete HA-4633 for me?
Yes. Your representative can prepare and submit it, but you must personally sign Field 8 because the certification of truthfulness is yours under HALLEX I-2-1-30.
Do I have to list every doctor, even unrelated ones?
Yes. SSR 02-1p and 20 CFR § 404.1523 require consideration of all impairments combined, so even unrelated visits can affect your RFC and credibility findings.
Will SSA pay for the records I list?
Yes. The agency reimburses providers at federally set rates per POMS GN 03311.005, so you should never pay out of pocket for records you list on HA-4633.
Can I email HA-4633 to the hearing office?
No. Standard email is not accepted because it is not secure under HIPAA, but Electronic Records Express, fax, and mail all work.
What if I miss the 5-day deadline?
Yes, the ALJ can still accept the form, but only if you show good cause under 20 CFR § 404.935(b), like an agency error, a serious medical limitation, or another unavoidable circumstance.
Does HA-4633 replace the SSA-827 release?
No. The SSA-827 authorizes release of records, while HA-4633 only identifies the providers, you typically need both at the hearing level.
Can I amend HA-4633 after submitting it?
Yes. You can submit an updated form or a supplemental letter at any time before the hearing, and HALLEX I-2-6-58 specifically contemplates rolling updates.
Will the ALJ ask me about HA-4633 at the hearing?
Yes. Most ALJs open the record by confirming on the record that HA-4633 is complete, which is your last chance to add a forgotten provider before testimony begins.
Is HA-4633 the same form used at the Appeals Council?
No. The Appeals Council uses different procedures, but the medical sources you listed on HA-4633 follow the case forward in the eFolder for review under 20 CFR § 404.970.
Can I refuse to list a provider for privacy reasons?
No. Refusing to identify a treating source can cause the ALJ to draw an adverse inference under SSR 16-3p, which is almost always worse than disclosure.
Does HA-4633 apply to SSI claims too?
Yes. It applies to both Title II disability and Title XVI SSI claims at the hearing level under parallel regulations at 20 CFR § 416.912 and 20 CFR § 416.1435.
Related reading
- How to Fill Out Form HA-4632 (w/Examples) + FAQs
- How to Fill Out Form HA-85 (w/Examples) + FAQs
- How to Fill Out Form HA-86 (w/Examples) + FAQs
- How to Fill Out Form SSA-3441-BK (w/Examples) + FAQs
- How to Fill Out Form SSA-5064 (w/Examples) + FAQs
- How to Fill Out Form SSA-552 (w/Examples) + FAQs
- How to Fill Out Form SSA-8001-BK (w/Examples) + FAQs