When you have requested or are requesting a hearing before an Administrative Law Judge (ALJ), use this form to tell us about the medications you take.
To ensure that we have current medical information, you should also complete an HA-4631, Claimant's Recent Medical Treatment. If you have worked since you filed your application for disability benefits, complete an HA-4633, Claimant's Work Background.
Where to send this form
Trải nghiệm sòng bạc trực tuyếnComplete the form and mail it 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.