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.