Form SSA-455: Disability Update Report

Form SSA-455 PDF Details

Within the last 2 years have you attended any school or work training program(s)?

Doctor or clinic: within the last 2 years have you gone to a doctor or clinic for your condition? If yes, show the date and the reason for the visit.

Hospital: if you have been hospitalized or had any surgery within the last 2 years, please list below Reason and Date (month/year).

Work: Work Began (month/year), Work Ended (month/year), Monthly Earnings.

Date report completed: Telephone Number, Date Report Completed (MM/DD/YYYY).