Request Prevail Merge Forms

Hearings and Appeals (17)

• HA-56 - Agreement to Appearing By Online Video (11-2024) Word only
• HA-4632 - Claimant's Medications (08-2025)
• HA-4631 - Claimant's Recent Medical Treatment (06-2010)
• HA-4633 - Claimant's Work Background (01-2026)
• HA-1151 - Medical Source Statement of Ability to do Work-Related Activities (Physical) (04-2009)
• HA-1152 - Medical Statement of Ability to do Work-Related Activities (Mental) (01-2017) Word only
• HA-539 - Notice Regarding Substitution of Party Upon Death of Claimant (09-2024) Word only
• HA-55 - Objection To Appearing by Video Teleconferencing (11-2024) Word only
• HA-501 - Request for Hearing by Administrative Law Judge (06-2022)
• HA-520 - Request for Review of Hearing Decision Order (10-2023) Word only
• HA-85 - Request To Withdraw A Hearing Request (06-2026) Word only
• HA-510 - Waiver of Written Notice of Hearing (07-2026)
• HA-4608 - Waiver of Your Right to Personal Appearance Before an Administrative Law Judge (12-2024) Word only
• ALJ Bench Decision Checksheet - Print Version
• COVID-19 Public Health Emergency Hearing Agreement Form
• NOSSCR Hearing Format Election Form (2023)
• Remote Hearing Agreement Form (2023)

Social Security Administration (43)

• SSA-4-BK - Application For Child's Insurance Benefits (05-2023) Word only
• SSA-16 - Application for Disability Insurance Benefits (09-2025) Word only
• SSA-8000-BK - Application for Supplemental Security Income (09-2024) Word only
• SSA-8001-BK - Application for Supplemental Security Income (07-2023) Word only
• SSA-10 - Application for Widows or Widowers Insurance Benefits (04-2026) Word only
• SSA-2-BK - Application for Wife's or Husband's Insurance Benefits (01-2026) Word only
• SSA-827 - Authorization to Disclose Information to the SSA (06-2024)
• SSA-8240 - Authorization for the SSA to Obtain Wage and Employment Information from Payroll Data Providers (07-2025) Word only
• SSA-1724-F4 - Claim for Amounts Due in the Case of a Deceased Beneficiary (10-2024) Word only
• SSA-1696 - Claimant's Appointment of Representative (12-2024)
• SSA-1696 - Claimant's Appointment of Representative with Instructions (12-2024)
• SSA-1696-SUP1 - Claimant's Revocation of the Appointment of a Representative (08-2019)
• SSA-3288 - Consent for Release of Information (02-2023)
• SSA-3368-BK - Disability Report - Adult (06-2024) Word only
• SSA-3441-BK - Disability Report - Appeal (06-2026)
• SSA-3820-BK - Disability Report - Child (03-2024) Word only
• SSA-1693 - Fee Agreement for Representation Before the Social Security Administration (12-2024) Word only
• SSA-3373 - Function Report - Adult (02-2024) Word only
• SSA-3380 - Function Report - Adult - Third Party (12-2023) Word only
• SSA-3381 - Medical and Job Worksheet - Adult (12-2009)
• SSA-4814 - Medical Report on Adult with Allegation of Human Immunodeficiency Virus (HIV) (07-2023) Word only
• SSA-787 - Medical Source Opinion of Patient's Capability to Manage Benefits (12-2018) Word only
• SSA-1560 - Petition for Authorization to Charge and Collect a Fee for Services Before the Social Security Administration (09-2024) Word only
• SSA-3881 - Questionnaire for Children Claiming SSI Benefits (01-2022) Word only
• SSA-1696-SUP2 - Representative's Withdrawal of Acceptance of an Appointment (07-2019)
• SSA-634 - Request for Change in Overpayment Recovery Rate (12-2023) Word only
• SSA-769 - Request for Change in Time or Place of Disability Hearing (02-2025) Word only
• SSA-561 - Request for Reconsideration (08-2025) Word only
• SSA-789 - Request for Reconsideration - Disability Cessation (06-2024) Word only
• SSA-61 - Request for Review by a Federal Reviewing Official (08-2006)
• SSA-7050-F4 - Request for Social Security Earnings Information (11-2024)
• SSA-7004 - Request for Social Security Statement (07-2023) Word only
• SSA-7708 - Request for Correction of Earnings Record (09-2023)
• SSA-632 - Request for Waiver of Overpayment Recovery or Change in Repayment Amount (09-2023) Word only
• SSA-521 - Request for Withdrawal of Application (07-2026) Word only
• SSA-795 - Statement of Claimant or Other Person (06-2022)
• SSA-754-F5 - Statement of Marital Relationship (01-2026) Word only
• SSA-792 - Statutory Benefit Continuation Election Statement (05-2025) Word only
• SSA-5665-BK - Teacher Questionnaire (01-2024) Word only
• SSA-820 - Work Activity Report - Self-Employed Person (03-2026) Word only
• SSA-821 - Work Activity Report - Employee (09-2025) Word only
• SSA-3369 - Work History Report (06-2024) Word only
• SSA-546 - Workers' Compensation/Public Disability Benefit Questionnaire (07-2025) Word only

Veterans Affairs (47)

• VA9 - Appeal to Board of Veterans' Appeals (03-2025)
• VA21P-601 - Application for Accrued Amounts Due a Deceased Beneficiary (08-2022)
• VA10-8678 - Application for Annual Clothing Allowance (06-2015)
• VA21-0966 - Intent to File a Claim for Compensation
• VA21P-530EZ - Application for Burial Benefits (10-2024)
• VA21-535 - Application for Dependency and Indemnity Compensation by Parent(s) (09-2022)
• VA21-534 - Application for Dependency and Indemnity Compensation
• VA21P-534EZ - Application for DIC (08-2025)
• VA21-526EZ - Application for Disability Compensation and Related Compensation Benefits (01-2026) Word only
• VA21-22A - Appointment of Individual as Claimant's Representative (07-2023)
• VA21-4142 - Authorization to Disclose Information to the Department of Veterans Affairs (08-2024)
• VA0857d - Administrative Closure of Accommodation Request (11-2013)
• VA21-0845 - Authorization to Disclose Personal Information to a Third Party (02-2023)
• VA - Centralized Intake Coversheet (07-2019) Word only
• VA40-1330M - Claim for Government Medallion for Placement in a Private Cemetery (03-2025) Word only
• VA40-1330 - Claim for Standard Government Headstone or Marker for Placement in a Private Cemetery or a State Veterans' Cemetery (07-2021) Word only
• VA20-0995 - Decision Review Request: Supplemental Claim (06-2024) Word only
• VA20-0996 - Decision Review Request: Higher Level Review (03-2024) Word only
• VA10182 - Decision Review Request: Board Appeal (Notice of Disagreement) (02-2025) Word only
• VA21-686c - Declaration of Status of Dependents (08-2025)
• VA20-10208 - Document Evidence Submission (08-2023) Word only
• VA21-4140 - Employment Questionnaire (08-2024) Word only
• VA21-2680 - Examination for Housebound Status or Permanent Need for Regular Aid and Attendance (02-2023)
• VA20-10206 - FOIA or PA Request (08-2023) Word only
• VA21-4142a - General Release for Medical Provider Information to the Department of VA (07-2024) Word only
• VA10-5345a - Individuals' Request for a Copy of Their Own Health Information (07-2021) Word only
• VA21P-0969 - Income and Asset Statement in Support of Claim for Pension or Parents Dependency and Indemnity Compensation (11-2023) Word only
• VA21-10210 - Lay Witness Statement (07-2024) Word only
• VA21-0538 - Mandatory Verification of Dependents (01-2024) Word only
• VA21P-8416 - Medical Expense Report (10-2023) Word only
• VA21-0958 - Notice of Disagreement (09-2018) Word only
• VA20-10207 - Priority Processing Request (08-2023) Word only
• VA10-5345 - Request for and Authorization to Release Medical Records or Health Information (10-2023) Word only
• VA3288 - Request for and Consent to Release of Information from Individual's Records (10-1995)
• VA21-674 - Request for Approval of School Attendance (11-2024) Word only
• VA20-572 - Request for Change of Address or Cancellation of Direct Deposit (03-1996) Word only
• VA21-4192 - Request for Employment Information in Connection with Claim for Disability Benefits (08-2024)
• VA10-10HS - Request for Hardship Determination (07-2024) Word only
• VA21P-0847 - Request for Substitution of Claimant Upon Death of Claimant (11-2024) Word only
• VA180 - Request Pertaining to Military Records (07-2023) Word only
• VA21-674b - School Attendance Report (10-2021)
• VA21-4138 - Statement in Support of Claim (07-2024)
• VA21-0781 - Statement in Support of Claim for Service Connection for PTSD (03-2024) Word only
• VA21-0781a - Statement in Support of Claim for Service Connection for PTSD Secondary to Personal Assault (06-2021) Word only
• VA21-526 - Veterans Application for Compensation and/or Pension (11-2014) Word only
• VA21-8940 - Veterans Application for Increased Compensation Based on Unemployability (09-2024)
• VA21-526b - Veterans Application for Compensation and/or Pension (06-2014)

Court of Appeals for Veterans Claims (3)

• CAVC Form 3 - Notice of Appearance
• CAVC Form 1 - Notice of Appeal
• CAVC Form 4a - Declaration of Financial Hardship - Rule 24

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