How to Fill Out Form HA-86 (w/Examples) + FAQs

Form HA-86, the Social Security Administration’s Claimant’s Medications form, is a one-page disclosure where you list every prescription and over-the-counter drug you take, the dose, how often you take it, the prescribing doctor, the condition treated, and the side effects you experience. You fill it out before your Administrative Law Judge (ALJ) hearing so the judge can weigh how your medications and their side effects affect your ability to work under SSR 16-3p symptom evaluation.

The governing problem is simple: federal regulations at 20 CFR §404.1529 require ALJs to consider the type, dosage, effectiveness, and side effects of any medication you take for symptom relief. If you leave HA-86 blank, fill it out wrong, or omit a drug, the judge can find your symptoms less credible, and that single credibility finding often controls whether benefits get awarded or denied.

According to the SSA’s FY 2024 Annual Performance Report, only about 49% of disability claims are approved at the ALJ hearing level, and incomplete medical evidence remains one of the top reasons for denial. A clean, accurate HA-86 is one of the cheapest, fastest ways to protect your record.

Here is what you will learn in this guide:

• 📋 How to complete every line of Form HA-86 without triggering credibility problems
• 💊 Which over-the-counter drugs, supplements, and PRN medications you must disclose
• ⚖️ How 20 CFR §404.1529 and SSR 16-3p turn medication side effects into approval evidence
• 🧾 Real-world examples for mental health, chronic pain, and cardiac claimants
• 🚫 The seven most common HA-86 mistakes that quietly sink hearings

What Form HA-86 Is and Why It Exists

Form HA-86 is the official SSA hearing-stage exhibit that captures your current medication regimen at the time of your ALJ hearing. The form is published under OMB control number 0960-0288 and is hosted at the SSA Forms Library. It is not a one-time disclosure. You should refresh it every time your prescriptions change, and you must bring an updated copy to the hearing itself.

The form exists because the agency cannot evaluate your symptoms in a vacuum. Under the plain English rule of 20 CFR §404.1529(c)(3)(iv), the ALJ must consider the type, dosage, effectiveness, and side effects of any medication you take. The consequence of an empty or sloppy HA-86 is real: judges routinely write decisions stating that the claimant failed to document significant medication side effects, and that finding becomes the legal basis for denial.

Picture Maria, a 52-year-old former cashier with fibromyalgia. She takes gabapentin three times a day and reports drowsiness so heavy she naps for two hours every afternoon. If Maria writes “gabapentin – drowsy” on HA-86, the judge has almost nothing to work with. If Maria writes “gabapentin 600 mg, three times daily, prescribed by Dr. Lin for fibromyalgia, causes 2-hour daily sedation between 1 p.m. and 3 p.m.,” the judge now has a documented residual functional capacity (RFC) limitation.

A common misconception is that HA-86 is just paperwork and that the medical records will speak for themselves. They will not. Treatment notes rarely capture functional side effects in the claimant’s own words, and HALLEX I-2-6-58 treats HA-86 as a separately admissible exhibit that the ALJ can rely on directly.

Where HA-86 Fits in the Appeals Pipeline

Form HA-86 is most often used at the ALJ hearing stage after a reconsideration denial. The SSA appeals process moves through four stages: reconsideration, ALJ hearing, Appeals Council, and federal district court. HA-86 enters the record at stage two, but it can resurface at the Appeals Council if new prescriptions started after the hearing.

The consequence of using the wrong stage form is that your evidence may be rejected as untimely under the five-day rule in 20 CFR §404.935. You must submit HA-86 at least five business days before the hearing, or show good cause for late submission. A real example: Darnell, a claimant in Atlanta, handed his HA-86 to the judge at the hearing table and the ALJ refused to admit it, citing the five-day rule.

A common misconception is that you can email HA-86 directly to the judge. You cannot. You must upload through the Electronic Records Express (ERE) portal or fax to the hearing office on file.

How HA-86 Connects to Other SSA Forms

HA-86 does not stand alone. It works alongside Form SSA-3373 Function Report, Form SSA-3441 Disability Report Appeal, and the SSA-827 medical release. Each form captures a different slice of evidence, and inconsistencies across them can torpedo credibility.

The consequence of a contradiction — for example, listing tramadol on HA-86 but not on SSA-3441 — is that the ALJ will assume one of the two forms is wrong, and the resulting credibility hit can affect the entire claim. Priya, a former nurse, listed Cymbalta on HA-86 but forgot to update SSA-3441; the judge cited the gap as evidence she was “not fully forthcoming,” and her claim was denied.

A common misconception is that the SSA pulls medication data automatically from your pharmacy. It does not. The agency has no live link to GoodRx, CVS, Walgreens, or any pharmacy benefit manager.

Where to Get Form HA-86 and What You Need First

You can download Form HA-86 directly from the SSA Forms Library, and your attorney or representative should also have a current PDF version. The form is also mailed to you with the Notice of Hearing packet once your case is scheduled, usually 75 days before the hearing date.

Before you start filling it in, gather four things: your current pill bottles, your pharmacy printout for the last 12 months, your MyChart or patient portal medication list, and a list of any over-the-counter drugs and supplements you take regularly. The consequence of working from memory alone is that claimants routinely forget PRN drugs like Xanax, Ambien, or albuterol, and those omissions show up later in pharmacy records the SSA pulls under 20 CFR §404.1512.

Take James, a veteran with PTSD. He filled out HA-86 from memory and forgot his as-needed prazosin for nightmares. The VA records later showed regular prazosin refills, and the ALJ wrote that the claimant’s testimony about sleep disturbance was inconsistent with the documented absence of nighttime medication. James lost the hearing on credibility.

A common misconception is that supplements do not count. They do. Melatonin, CBD, magnesium for restless legs, and St. John’s Wort all interact with prescription drugs and all belong on HA-86, especially when they treat a symptom tied to your alleged impairment.

Line-by-Line Walkthrough of Form HA-86

The form has six labeled columns plus a header block. Each column is small, but the consequences of each entry are large. Use a separate continuation sheet if you take more than ten medications; the HALLEX exhibit rules allow attached pages so long as they are clearly labeled.

The header block requests your name, Social Security number, and the date you completed the form. Use your full legal name as it appears on your SSA-1696 representative appointment, match the SSN on your Notice of Hearing, and date the form within five days of submission. The consequence of stale dating is that the judge may discount the form as outdated, especially if your hearing is more than 30 days away.

A common misconception is that the form must be typed. It does not. Legible handwriting in blue or black ink is acceptable under HALLEX I-2-1-15, but typed entries are easier for the judge to read and reduce transcription errors.

Column 1: Name of Medicine

List the brand name and the generic name together, separated by a slash. Example: “Cymbalta/duloxetine.” This matters because ALJs and medical experts (MEs) sometimes recognize one name but not the other, and a missing generic can cause the ME to question whether the drug is really being taken.

The consequence of using only a brand name is that the vocational expert (VE) and ME may search the wrong drug class. A real example: Linda listed only “Effexor” and the ME asked whether she had tried any SNRIs; the judge later noted “no documented SNRI trial” even though Effexor is an SNRI.

A common misconception is that you can write “anti-anxiety pill” or “blood pressure med.” You cannot. Generic descriptors are treated as non-responsive under SSR 16-3p.

Column 2: Dosage

Write the strength and the unit: “20 mg,” “500 mcg,” “5 mL,” or “1 patch.” Do not write “small,” “low dose,” or “the orange one.” Dosage matters because SSR 16-3p treats high-dose therapy as evidence of greater symptom severity.

The consequence of vague dosing is that the ALJ cannot tell whether you are on a starter dose or a maximum dose. Marcus, a chronic pain patient, wrote “OxyContin – as prescribed.” The judge wrote that the dosage was unspecified and therefore not probative of severe pain. Had Marcus written “OxyContin 80 mg ER twice daily,” the dosage alone would have signaled severe pain consistent with CDC opioid prescribing guidance.

A common misconception is that you should round dosages. You should not. Write the exact strength on the bottle.

Column 3: How Often Taken

Spell out the frequency: “twice daily,” “every 8 hours,” “every Monday, Wednesday, Friday,” or “as needed up to 4 times per day.” Avoid Latin abbreviations like q.d., b.i.d., t.i.d., or PRN without explanation. The judge is a lawyer, not a pharmacist, and clarity protects the record.

The consequence of unclear frequency is that the ALJ cannot calculate cumulative side-effect exposure. For PRN drugs, write the actual average use, not the prescribed maximum. Aisha wrote “lorazepam – PRN” and the judge assumed she rarely took it; in reality she took it three times a day. The pharmacy printout later confirmed her real use, and the credibility damage was done.

A common misconception is that PRN means optional. It does not. PRN drugs you actually take are fully disclosable and fully relevant under 20 CFR §404.1529(c)(3)(iv).

Column 4: Prescribed By (Doctor)

Provide the prescribing doctor’s full name, specialty, and clinic. Example: “Dr. Anita Lin, MD, rheumatologist, Mercy Pain Clinic.” Specialty matters because a drug prescribed by a specialist carries more diagnostic weight under the hierarchy of medical opinion evidence in 20 CFR §404.1520c.

The consequence of leaving the doctor blank is that the ALJ may assume the drug is self-prescribed or obtained without medical supervision. For drugs prescribed in the ER or urgent care, list the facility name and the date of the visit. Rebecca, who got a Medrol Dosepak from urgent care, listed “Urgent Care – 3/14/2026” and the judge accepted the entry without follow-up.

A common misconception is that you must list your primary care doctor for every drug. You should list the actual prescriber, even if that is a psychiatrist, neurologist, or pain specialist who only sees you quarterly.

Column 5: For (Condition Treated)

Match the condition to your alleged impairments listed on Form SSA-3368 Disability Report. Example: “fibromyalgia,” “major depressive disorder,” “diabetic neuropathy.” Avoid lay terms like “nerves” or “stomach problems.”

The consequence of a mismatched condition is that the judge may decide the medication treats something unrelated to your disability claim, which weakens the symptom-severity evidence. Tomas listed Lexapro “for stress.” The judge wrote that stress is not a medically determinable impairment under 20 CFR §404.1521. Had he written “major depressive disorder,” the entry would have supported his alleged mental impairment.

A common misconception is that off-label use should be hidden. It should not. If your doctor prescribes gabapentin for anxiety, write “anxiety (off-label use)” — this is honest, accurate, and protects you from later impeachment.

Column 6: Side Effects

This is the most important column. Describe each side effect in functional terms: “drowsiness causing 2-hour afternoon nap,” “tremor preventing handwriting,” “dry mouth requiring water every 15 minutes,” “dizziness on standing, two falls in last 30 days.” Vague entries like “tired” or “weird” do not move the needle.

The consequence of weak side-effect descriptions is that the ALJ cannot translate them into RFC limitations. Under SSR 96-8p, the RFC must reflect all limitations, including those caused by medication. Henry, on high-dose prednisone, wrote “moon face, mood swings, can’t sleep more than 4 hours.” The judge incorporated a sleep-related limitation into the RFC and Henry won.

A common misconception is that listing too many side effects looks like exaggeration. The opposite is true: under-reporting is the bigger risk, and the FDA drug label database supports virtually every common side effect you might list.

Three Real-World HA-86 Scenarios

Below are three scenario tables based on the most common HA-86 fact patterns. Each shows a typical entry and the consequence at the hearing.

Scenario 1: Mental Health Claimant on Polypharmacy

HA-86 Entry Quality	Hearing Consequence
Lists Zoloft only, omits trazodone and Klonopin	ALJ finds inconsistent symptom reporting, denies claim under SSR 16-3p
Lists all three drugs with doses but no side effects	ALJ accepts diagnosis, gives partial RFC reduction, often denies at step 5
Lists all three with dose, frequency, prescriber, and functional side effects (sedation, weight gain, cognitive fog)	ALJ builds mental RFC with concentration and pace limits, frequently approves

Scenario 2: Chronic Pain Claimant on Opioids

HA-86 Entry Quality	Hearing Consequence
Writes “pain meds – as prescribed”	ALJ writes pain treatment is unspecified, denies under 20 CFR §404.1529
Lists oxycodone 10 mg q6h with no side effects	ALJ acknowledges severe pain but finds no functional limit beyond exertional restriction
Lists oxycodone 10 mg q6h, gabapentin 600 mg TID, lidocaine patch, plus constipation, sedation, and concentration loss	ALJ adds off-task and absenteeism limits, often approves at step 5

Scenario 3: Cardiac Claimant on Multiple Heart Drugs

HA-86 Entry Quality	Hearing Consequence
Lists metoprolol only, omits Lasix and Eliquis	ALJ questions cardiac severity, may deny under Listing 4.02
Lists all three with dose, no side effects	ALJ accepts diagnosis, gives light-work RFC
Lists all three plus orthostatic dizziness, frequent urination from Lasix, and bleeding risk from Eliquis	ALJ adds bathroom-break and fall-risk limits, often approves

Three Named Examples Walked Through

Below are three full HA-86 walkthroughs using fictional but realistic claimants. Use them as a template for your own form.

Example 1: Sofia, 47, Major Depression and Generalized Anxiety

Sofia takes Lexapro 20 mg once daily, prescribed by Dr. Patel (psychiatrist) for major depressive disorder, with side effects of nausea for the first 30 minutes and decreased libido. She also takes BuSpar 15 mg twice daily for generalized anxiety with side effect of light-headedness for one hour after each dose. She takes Ambien 10 mg at bedtime PRN, used 5 nights per week, with side effect of next-morning grogginess until 10 a.m. Her HA-86 lists every drug, every prescriber, and translates each side effect into a time-of-day functional limitation, which gives the judge a clean roadmap to a mental RFC under POMS DI 24510.060.

Example 2: Robert, 58, Lumbar Degenerative Disc Disease

Robert takes hydrocodone 5/325 mg every 6 hours, prescribed by Dr. Nguyen (pain management) for lumbar radiculopathy, with side effects of constipation requiring daily MiraLAX and sedation lasting 90 minutes after each dose. He takes Flexeril 10 mg three times daily for muscle spasm, with side effect of dry mouth and difficulty speaking clearly for one hour. He takes Aleve 220 mg twice daily for breakthrough pain, prescribed OTC, with side effect of stomach upset. His HA-86 captures cumulative sedation of roughly six hours per day, which supports an off-task limitation greater than 15% under typical vocational expert testimony.

Example 3: Yolanda, 61, Type 2 Diabetes with Neuropathy

Yolanda takes metformin 1000 mg twice daily, prescribed by Dr. Brown (endocrinologist) for type 2 diabetes, with side effect of GI urgency requiring bathroom access within 5 minutes after meals. She takes Lyrica 75 mg twice daily for diabetic neuropathy, with side effects of dizziness and 2-hour afternoon sedation. She takes insulin glargine 30 units at bedtime, with no significant side effects. Her HA-86 entry on metformin alone supports a bathroom-access RFC limitation that often eliminates the unskilled sedentary base of jobs cited at step 5 under the Medical-Vocational Guidelines.

Mistakes to Avoid on HA-86

Even claimants represented by experienced attorneys make these mistakes. Each one carries a specific negative outcome.

• Omitting PRN medications. The pharmacy record will show them, and the judge will note the inconsistency under SSR 16-3p, reducing your credibility.
• Listing only brand names. The medical expert may search the wrong drug class and miss your treatment history, leading to an unfavorable medical opinion.
• Writing vague side effects like “tired.” The ALJ cannot translate “tired” into an RFC limitation, and the side-effect column becomes worthless.
• Forgetting OTC drugs and supplements. Melatonin, ibuprofen, and CBD all matter, and their absence suggests under-treatment of symptoms you claim are severe.
• Submitting after the five-day deadline. Under 20 CFR §404.935, late forms can be excluded entirely, leaving the record without medication evidence.
• Failing to update before the hearing. Judges expect the form to reflect your current regimen, and a stale form invites questions about whether you are still in active treatment.
• Mismatching conditions across forms. If HA-86 says “anxiety” but SSA-3368 says “PTSD,” the judge will pick the weaker characterization, which can change the listing analysis.
• Hiding off-label use. Off-label prescribing is legal and common, and disclosure protects you from impeachment by the medical expert.
• Skipping the prescriber’s specialty. A specialist’s prescription carries more diagnostic weight under 20 CFR §404.1520c than a primary care prescription.
• Writing illegibly. Hearing offices scan the form into the eFolder, and unreadable handwriting may be excluded as non-probative.

Do’s and Don’ts for HA-86

The following do’s and don’ts come straight from common ALJ decisions and HALLEX I-2-6-58 practice.

Do:

• Do list every drug, OTC and prescription, because 20 CFR §404.1529 requires consideration of all medications.
• Do describe side effects in functional, time-of-day terms because that is what the judge needs for the RFC.
• Do include both brand and generic names because medical experts look them up differently.
• Do update the form within five days of your hearing because stale forms invite skepticism.
• Do keep a copy for yourself because the judge may ask you to authenticate it under oath.

Don’t:

• Don’t write “as needed” without estimating actual frequency because PRN with no number tells the judge nothing.
• Don’t use Latin pharmacy abbreviations because they create ambiguity in the written decision.
• Don’t omit drugs you stopped recently because the 12-month duration rule in 20 CFR §404.1509 makes recent treatment relevant.
• Don’t copy the form from a prior hearing because regimens change and old forms create contradictions.
• Don’t sign someone else’s name because that is a federal offense under 18 U.S.C. §1001.

Pros and Cons of Filing HA-86 Without an Attorney

Some claimants complete HA-86 pro se, while most use a representative under SSA-1696. Both approaches have trade-offs.

Pros of pro se HA-86:

• Speed: You can complete and submit it the same day you receive the Notice of Hearing, avoiding any representative bottleneck.
• Cost: No fee agreement is needed, which preserves the 25% / $9,200 fee cap for other tasks.
• Voice: Your own words go directly into the record, which can feel more authentic to some judges.
• Control: You decide what side effects to emphasize without secondhand interpretation.
• Learning: Filling it out yourself teaches you the disability evidence framework, which helps at the hearing itself.

Cons of pro se HA-86:

• Missed nuance: Attorneys know which side effects align with which RFC limits, and pro se forms often leave value on the table.
• Deadline risk: The five-day rule under 20 CFR §404.935 is unforgiving and easy to miss.
• Form-cross-checking: Lawyers reconcile HA-86 with SSA-3441, SSA-3368, and treatment notes to avoid contradictions.
• eFolder access: Without ERE access, pro se claimants often must mail or fax, which slows the process.
• Hearing prep: Attorneys use HA-86 to script direct examination, which pro se claimants rarely do.

State-Level Nuances

Although Form HA-86 is a federal SSA form used in every state, parallel state disability programs have analogous medication forms. California’s State Disability Insurance (SDI) uses the DE 2501 medical certification, which captures a shorter medication list. New York’s NYS Disability Benefits Law requires Form DB-450, and New Jersey’s Temporary Disability Insurance uses Form DS-1.

The consequence of confusing state and federal forms is that you may submit the wrong document to the wrong agency, delaying both claims. A real example: Carlos in Sacramento submitted his HA-86 to EDD instead of the SSA hearing office; the EDD returned it, and by the time he refiled with the SSA, he had missed the five-day rule. Always send HA-86 only to the SSA hearing office identified on your Notice of Hearing.

A common misconception is that state short-term disability records replace HA-86. They do not. The SSA requires its own form even when state records cover the same period.

How HA-86 Interacts With Court Rulings

Several federal court rulings shape how ALJs must use HA-86. In Lingenfelter v. Astrue, 504 F.3d 1028 (9th Cir. 2007), the Ninth Circuit held that an ALJ may not reject a claimant’s symptom testimony without addressing medication side effects in the record. In Reddick v. Chater, 157 F.3d 715 (9th Cir. 1998), the court emphasized that side effects can independently support an RFC reduction.

The consequence of these rulings is that a complete HA-86 gives you appellate ammunition: if the ALJ ignores your documented side effects, the Appeals Council or a federal district court can remand under 42 U.S.C. §405(g). In Schmidt v. Astrue, 496 F.3d 833 (7th Cir. 2007), the Seventh Circuit noted that side effects must be supported by objective evidence, which is exactly what HA-86 helps build alongside treatment notes.

A common misconception is that a court will reweigh your evidence. It will not. Federal courts review only for substantial evidence under 42 U.S.C. §405(g), and a complete HA-86 is what makes substantial evidence visible on the record.

How to Submit HA-86 to SSA

Once HA-86 is complete, submit it through the Electronic Records Express portal if you are represented, or by fax or mail to the hearing office on your Notice of Hearing if you are pro se. Keep the fax confirmation page or the ERE upload receipt because it is your proof of timely filing under 20 CFR §404.935.

The consequence of poor submission proof is that, if the form goes missing, you bear the burden of showing it was timely sent. Nia, a claimant in Houston, mailed her HA-86 without certified mail; the hearing office had no record, and the judge declined to admit it. Always use certified mail, fax with confirmation, or ERE with a saved receipt.

A common misconception is that handing the form to the judge at the hearing satisfies the rule. It does not. The five-day rule is calculated from receipt by the hearing office, not by the judge.

FAQs

Is Form HA-86 legally required?

No. It is not statutorily required, but HALLEX I-2-6-58 treats it as standard ALJ-stage evidence, and skipping it almost always weakens your claim under 20 CFR §404.1529.

Do I have to list over-the-counter medications?

Yes. OTC drugs and supplements that treat your alleged impairments are part of your treatment record under SSR 16-3p, and omitting them creates credibility gaps the ALJ will note.

Can I submit HA-86 after the five-day deadline?

Yes, but only with good cause. Under 20 CFR §404.935(b), good cause includes hospitalization, mail delays, or unrepresented status, but the judge has discretion to refuse.

Does the ALJ have to consider my listed side effects?

Yes. Under 20 CFR §404.1529(c)(3)(iv), the ALJ must consider medication type, dosage, effectiveness, and side effects, and failure to do so is reversible error in many circuits.

Can I update HA-86 the day before my hearing?

Yes, but you should also explain the change at the hearing, and any drug added in the last five days will be subject to good-cause review under 20 CFR §404.935.

Is HA-86 used at the Appeals Council?

Yes, when new prescriptions begin after the ALJ decision, an updated HA-86 may be submitted with an Appeals Council appeal under 20 CFR §404.970, subject to the new-and-material standard.

Does HA-86 replace my medical records?

No. HA-86 supplements treatment notes by giving the judge a single, organized snapshot of medications and side effects, but the underlying records remain the primary medical evidence.

Can my attorney sign HA-86 for me?

No. The form requires the claimant’s signature because it is a personal disclosure of medication use, and signing for someone else may violate 18 U.S.C. §1001.

Are marijuana and CBD products listed on HA-86?

Yes, if you use them to treat symptoms tied to your alleged impairments, because SSR 16-3p covers all symptom-relief substances, even those that are federally illegal.

Will HA-86 affect my federal court appeal?

Yes, indirectly. A complete HA-86 builds the substantial-evidence record reviewed under 42 U.S.C. §405(g), and missing entries make remand harder to win on side-effect grounds.

Do I need a separate HA-86 for SSI and SSDI?

No. One form covers both SSDI and SSI when your hearing addresses concurrent claims, but list every drug regardless of which program pays for it.

Can I bring extra medication notes to the hearing?

Yes. You may bring a continuation page or a typed addendum, but it should be submitted through the hearing office at least five days before the hearing under 20 CFR §404.935 to avoid exclusion.