Form SSA-3441-BK

How to Fill out Form SSA-3441-BK in Washington, D.C.

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. Filling out a Form SSA-3441 is the first step in the appeals process.

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.

Form SSA-3441 is called the “Disability Report – Appeal.” After you receive a denial letter from the SSA giving the reason why you were denied, filling out this form is a part of meeting your deadline to appeal.

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.


For Form SSA-3441, you’ll need to have:

  • Details of your medical condition
  • Information about your medical records
  • Details about doctors or other health care professionals you’ve seen
  • Details about hospitals and clinics where you have gone for treatment
  • Information about medications you have taken
  • Details about medical tests you have received
  • An update of your work status
  • An update about your daily activities


The most important thing to know about filling out Form SSA-3341 is don’t leave anything blank.

If a question doesn’t seem to apply to you, mark it “I don’t know” or “Not applicable.” If a question seems repetitive, fill it out anyway.

If you leave a blank field, it could delay your appeal.

Also, make sure to submit the form before the deadline that the SSA gives you. This keeps your claim open and active. Keep close track of the deadline.

And include copies of your medical records. As you gather your answers to this form, keep copies of your medical records.

These records will give you a stronger case as you go through the appeals process. You probably need to update your file with more information about treatment you received since you filed your initial application.


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.

You can relieve the burden on you 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 Maths & Mathis we can help you with Form SSA-3441 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 medical evidence and work history records, 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 SSA-3441. We will evaluate your case for free.

Form SSA-3441-BK

Questions about this form? Contact us today.