Social Security Forms

Form HA-4633

Claimant's Work Background

When you have requested, or are requesting, a hearing before an Administrative Law Judge (ALJ), use this form to tell us about any work you have performed since you filed your claim for disability benefits.

If you are not certain whether you told us about work you have done, including work you may have done before you filed your application, include that work on this form.

To ensure that we have current medical information, you should also complete an HA-4631, Claimant's Recent Medical Treatment, and an HA-4632, Claimant's Medications

How to Obtain the Form

Below you will find Form in Portable Document Format (PDF). To print the PDF version, you will need the Adobe Acrobat reader software. If you do not already have this special software, see our page on downloading and printing PDF documents. After you download the Adobe Acrobat Reader, come back to this page and download the PDF version of the HA-4633:

Claimant's Work Background, HA-4633

How to Complete the Form

CLAIMANT and SOCIAL SECURITY NUMBER: Enter your name and Social Security number (SSN) or, if you are not the claimant, the name and SSN of the person on whose behalf the request for hearing was filed.

WAGE EARNER AND SOCIAL SECURITY NUMBER: If you receive or are applying for Social Security benefits on someone else's work record, enter that person's name and SSN.

The last time we brought your case up-to-date was: Enter the date you last gave up information about your work activity.

In the rest of the form, tell us about any work you have done since you filed for disability benefits. Also, tell us about any work you have done in the last 15 years that you may not have told us about when you filed your application.

Start with your most recent work and give the dates of you worked, the name and address of your employers, and the duties you performed for all the jobs that you have held since you last gave us information about your work. Please print.

If you need more space, use additional sheets of paper. Include your name and SSN on any additional pages, and on all correspondence, you send to us.

Send the Form

Where To Send The Form

Print the PDF HA-4633 form on 8 1/2 x 11 inch paper, complete and sign form, and mail to the hearing office where your claim is located. The address and telephone number of the hearing office are on the letter acknowledging receipt of the request for hearing that we sent.


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