Please rate Ssa 455 Ocr Sm 07-2023
Furnishing us this information is voluntary. However, failing to provide us with all or part of the information may prevent an accurate and timely decision on any claim filed.
Work: within the last 2 years have you worked for someone or been self-employed? If yes, please complete the information below.
Health: check the block which best describes your health within the last 2 years: Better, Same, Worse.
Return to work: within the last 2 years has your doctor told you that you can return to work?
Rehabilitation: would you be interested in receiving rehabilitation or other services that could help you get back to work?
Hospital: within the last 2 years have you been hospitalized or had any surgery?
| Question | Answer |
|---|---|
| Form Name | Form SSA-455 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 52 |
| Avg. time to fill out | 9 min |
| Edition | 07-2023 |
| Issuing agency | Social Security Administration |
| Other names | SSA-455, SSA 455, Form SSA-455, SSA-455-OCR-SM, Disability Update Report, SSA disability update form |
| Official source | Form SSA-455 (Rev 07-2023), Social Security Administration |
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Please rate Ssa 455 Ocr Sm 07-2023
