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Prevail forms are only available to those Prevail users with a current technical support contract in place.  If you would like to inquire about the status of your technical support contract, please call 407.228.4400 before submitting this form.

Complete the form below to request forms and the files will be emailed to you upon verification of your eligibility to receive free forms.  Please fill out this entire form.  Incomplete requests will not be honored. 

If you'd like to request a document that is not listed below, please send an email to forms@prevail.net for pricing information for document creation.

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  Form(s) Requested (check all that apply):
  HA-1151 - Medical Source Statement of Ability to do Work-Related Activities (Physical) (4-1999)
  HA-1152 - Medical Source Statement of Ability to do Work-Related Activities (Mental) (11-2002)
  HA-4631 - Claimant's Recent Medical Treatment (5-2000)
  HA-4632 - Claimant's Medications (9-2000)
  HA-4633 - Claimant's Work Background (10-2004)
  HA-501 - Request for Hearing by Administrative Law Judge (5-2007)
  HA-510 - Waiver of Written Notice of Hearing (10/2004)
  HA-520 - Request for Review of Hearing Decision/Order (5-2005)
  HA-539 - Notice Regarding Substitution of Party Upon Death of Claimant (10/2000)
  SSA-1560 - Petition to Obtain Approval of a Fee for Representing a Claimant Before the SSA (2-2005)
  SSA-16 - Application for Disability Insurance Benefits (7-2005)
SSA-1695 - Identifying Information for Possible Direct Payment of Authorized Fees (9-2006)
  SSA-1696 - Appointment of Representative (2-2008)
  SSA-3288 - Consent for Release of Information (5-2007)
  SSA-3368 - Disability Report - Adult (2-2004)
  SSA-3369 - Work History Report (1-2006)
  SSA-3373 - Function Report - Adult (6-2004)
  SSA-3441 - Disability Report - Appeal (10-2006)
  SSA-3820 - Disability Report - Child (7-2003)  *AVAILABLE IN WORD ONLY*
  SSA-3381 - Medical and Job Worksheet - Adult (4-2005)
  SSA-521 - Request for Withdrawal of Application (2-2005)
  SSA-546 - Workers' Compensation/Public Disability Benefit Questionnaire (9/2007)  *AVAILABLE IN WORD ONLY*
  SSA-561 - Request for Reconsideration (3-2006)
SSA-61 - Request for Review by a Federal Reviewing Official (8-2006)
SSA-632 - Request for Waiver of Overpayment Recovery or Change in Repayment Amount (6/2007)  *AVAILABLE IN WORD ONLY*
SSA-7004 - Request for Social Security Statement (10/2006)  *AVAILABLE IN WORD ONLY*
  SSA-789 - Request for Reconsideration - Disability Cessation (3-2003)
  SSA-795 - Statement of Claimant or Other Person (12-2005)
  SSA-8001 - Application for Supplemental Security Income (12-2002)
  SSA-821 - Work Activity Report - Employee (12-2005)
  SSA-827 - Authorization to Disclose Information to the SSA (6-2007)
  SSA-827 - Authorization to Disclose Information to the SSA (Includes Instructions Page) (6-2007)
 ALJ Bench Decision Checksheet - Print Version
 

 

 

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