Social Security Disability Appeals Report


What is Social Security Form SSA-3441(Social Security Disability Appeal Report?

When you're dealing with bad health and can't work, SSDI income could be a financial lifeline for you. The trouble is, most people who apply get denied. If you are denied for Social Security Disability, one of the forms you will have to complete is the Social Security Disability Appeal Report (SSA-3441). This form is part of the appeal process and helps your DDS examiner know where you are going to the doctor, the medications you take and information about how you are feeling. This form is lengthy and asks several questions about your disability that you may have to research to answer. Be sure that you include correct information when you fill out this form. 

How long do I have to file the Disability Appeal Report?

60 days with a 5 day grace period. If you wait too long, the Social Security Administration (SSA) may reject any forms you send. You'll be forced to file a new application and start the process over. If you do choose to appeal (and in most cases, you should), you can fill out Form SSA-3441 online or fill out a physical form.

What is each section on the disability appeal report about?

Below see a breakdown of the disability appeal report:

  • Section 1 – Information about the Disabled Person – this section is basic questions about you. The important piece of this section is D. When you give the name of someone whom the SSA can contact about your condition make sure you put someone down who knows about your condition and WILL respond to the forms that SSA sends them.
  • Section 2 – Information about your Illnesses, Injuries or Conditions – this section asks you about any changes in your medical condition and when those changes occurred. You should write down exactly what is going on with you or if you have been diagnosed with any new illnesses.
  • Section 3  – Information about your Medical Records – this section is very important. This is how DDS knows what medical records to order on your case. Write down everywhere you have been for treatment. If you do not include all of this information DDS will not order the medical records and will make a decision on your case based on the records that they have.
  • Section 4 – Medications – Please list your actual side affects from your medications. Do not write down the side affects that are listed on your medication bottle.
  • Section 5 – Tests – If you have had any medical testing write down when and where it occurred.
  • Section 6 – Updated Work Information – Have you been working? If so explain on a separate piece of paper or in the Remarks (Section 10).
  • Section 7 – Information about your activities – How have your daily activities changed? Are you having problems bathing, cooking, cleaning, etc?
  • Section 8 – Education/Training Information – Have you taken any classes since you became disabled?
  • Section 9 – Vocational Rehabilitation – VR can help people find other jobs. If you have been to VR write down which VR you have been to and if they have done any testing on you.
  • Section 10 – Remarks – You can include any information that you could not fit into any of the sections above.

This form helps the Social Security Administration process your disability claim quickly. Your DDS examiner is not the only person who will see this form DDS doctors or an  Administrative Law Judge (ALJ) will view this document as well. At Betz and Baril, we have helped many clients through the Social Security Disability Process. Be sure to complete SSA Disability Appeal Report Form SSA-3441 as soon as possible and return it to the Social Security Administration.


It's important not to leave anything blank on the form—even if a question doesn't apply to your case. If the question doesn't apply, put “I don't know” or “Not applicable.” Leaving some answers blank can delay your appeal. Remember, file your appeal by the deadline the SSA gives you. Doing this keeps your claim open and active and saves you from having to start over.

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