PDF
Word
This version of the form is not currently in use and is provided for reference only. Download this version of
Form SSA-4814
for the current year.
Form SSA-4814 Medical Report on Adult With Allegation of Human Immunodeficiency Virus (HIV) Infection
What Is Form SSA-4814?
This is a legal form that was released by the U.S. Social Security Administration on January 1, 2020 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the Form SSA-4814?A: Form SSA-4814 is a medical report on an adult with an allegation of HIV infection.
Q: What is the purpose of Form SSA-4814?A: The purpose of Form SSA-4814 is to gather medical information about an adult who has made an allegation of HIV infection for disability evaluation purposes.
Q: Who uses Form SSA-4814?A: Form SSA-4814 is used by the Social Security Administration (SSA) for disability evaluation.
Q: What information is requested on Form SSA-4814?A: Form SSA-4814 requests medical information related to the diagnosis, treatment, and clinical findings of the individual with an allegation of HIV infection.
Q: Is completion of Form SSA-4814 mandatory?A: Yes, completion of Form SSA-4814 is mandatory if an individual has made an allegation of HIV infection and is applying for disability benefits.
Q: Are there any fees associated with Form SSA-4814?A: No, there are no fees associated with completing and submitting Form SSA-4814.
Q: What should I do if I need help completing Form SSA-4814?A: If you need assistance completing Form SSA-4814, you can contact your local Social Security office or consult with a healthcare professional.
Q: Can I submit Form SSA-4814 electronically?A: At the time of writing this document, Form SSA-4814 cannot be submitted electronically. It needs to be printed, filled out manually, and submitted by mail or in person.
Form Details:
- Released on January 1, 2020;
- The latest available edition released by the U.S. Social Security Administration;
- Easy to use and ready to print;
- Yours to fill out and keep for your records;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form SSA-4814 by clicking the link below or browse more documents and templates provided by the U.S. Social Security Administration.
Download Form SSA-4814 Medical Report on Adult With Allegation of Human Immunodeficiency Virus (HIV) Infection
1
2
3
4
