Form HA-4633

How to Fill out Form HA-4633 in Washington DC

If you’ve been denied Social Security Disability benefits, you’re not alone.

Most people get denied the first time they apply. You should consider appealing the decision. Part appealing is filling out Form HA-4633, which is called “Claimant’s Work Background.”

Don’t wait to appeal, because the Social Security Administration (SSA) has a deadline for appeals and could make you start your application again if you’re too late.

To appeal your denial, you’ll have two other forms you need to submit before you complete Form HA-4631.

First, complete Form HA-4486: “Claimant’s Statement When Request for Hearing is Filed and the Issue is Disability.”

Also, fill out Form SSA-3441-BK: “Disability Report – Appeal.”

Once you’re finished with those, you’ll next be asked to fill out Form HA-4633.

You must submit the form before the SSA’s deadline, or you risk having to start over from the beginning with your application.

You can fill out the form online, or fill out and return a paper form.


This form covers your work history. You’ll need to list several details:

  • Dates of employment
  • Names and locations of employers
  • Duties you performed in each job


Most of the time, you’ll need to include 15 years of work history – going back from the date when you first experienced your disability – on Form HA-4633.

Fill out the form as honestly and completely as you can.

With this form, the SSA is trying to decide if you disability prevents you from doing your previous work, or if you can adjust to a different kind of work.

If you had a physically demanding job in construction, for example, could you still switch to a clerical job in an office?

You need to prove to Social Security that your medical condition is severe enough that you couldn’t work any job.

Form HA-4633 is a chance to give a clear picture of your work history to the administrative law judge who will decide on your case in a hearing.


When you’ve been denied Social Security Disability benefits and need to appeal, we highly recommend working with a disability advocate.

This stage in the process is complicated.

It’s enough stress dealing with health problems that keep you from work. You can relieve the burden on yourself and give yourself the best chance at winning benefits by getting help from a professional disability representative.

Mathis & Mathis has helped thousands of people win disability benefits for more than 20 years. Some of our senior staff members have worked for the SSA. We understand how the system works and where you can run into problems.

At Mathis & Mathis we can help you with Form HA-4631 and all the forms you need to apply and appeal for Social Security Disability benefits.

We’ll also help you prepare for your hearing with a judge, gathering all your work history records – and all the medical evidence you need – ensuring that you have a strong case.

Call us right away if you were denied your disability claim, so you don’t lose time to put together your appeal.

Contact us if you need help with Form HA-4633. We will evaluate your case for free.

Form HA-4633

Questions about this form? Contact us today.