The medical source statements, medical reports and certifications that Social Security and the Railroad Retirement Board ask treating clinicians to complete for disability and SSI claims.
For SSDI and SSI hearings, the forms clinicians see most are the medical source statements: the HA-1151 on physical abilities such as lifting, sitting, standing and manipulation, and the HA-1152 on mental abilities. Other SSA forms cover a beneficiary's capability to manage benefits (SSA-787), HIV infection in adults and children (SSA-4814 and SSA-4815) and low birth weight (SSA-3830). Railroad workers go through the Railroad Retirement Board, which uses the SI-1b for sickness benefits and the G-250 for disability.
Many of these forms arrive per case rather than being posted for download. Hearing offices, the state Disability Determination Services (DDS) and claimant representatives send the HA-1151 and HA-1152, and you can return them through Electronic Records Express. When a claimant's records are not enough, the DDS buys a consultative exam under its fee schedule. The RRB does not accept a stamped signature on the G-250. Vero Documents fills PDF forms like these from the visit note and the chart; you review and sign.
Records a medical source's opinion of a claimant's physical residual functional capacity (lifting, sitting, standing, manipulation, postural and environmental limits) for an SSDI/SSI hearing.
Records a medical source's opinion of a claimant's mental work-related abilities (understanding, interacting, concentrating, adapting) rated none to extreme, for an SSDI/SSI hearing.
Narrative exam report (with any requested medical source statement) that a DDS purchases when the claimant's own records are insufficient to decide an SSDI/SSI claim.
Gives the medical source's opinion on whether an adult beneficiary can manage or direct the management of Social Security/SSI benefits, so SSA can decide on direct payment or a representative payee.
Lets an SSI recipient keep full payments during a medical-facility stay of 90 days or less; the physician certifies the expected length of stay.
Certifies a newborn's birth weight, gestational age and neonatal conditions from hospital records so SSA can find the infant disabled for SSI under the low-birth-weight rules.
Documents HIV diagnosis and qualifying HIV-related conditions (CD4 counts, opportunistic illnesses) so SSA can decide an adult disability claim and possible presumptive (early) payments.
Documents HIV diagnosis and HIV-related conditions and growth/functional effects in a child so SSA can decide an SSI childhood disability claim and possible presumptive payments.
Health care provider's certification of diagnosis, period of inability to work, surgery/hospitalization and expected return to work, supporting a Railroad Unemployment Insurance Act sickness-benefit application.
G-250Treating physician's body-system medical assessment (exam findings, range of motion, diagnoses) used by the RRB to decide a Railroad Retirement Act disability annuity.
Records the treating source's opinion of the claimant's exertional, postural, manipulative and environmental limits for an RRB disability determination.
Documents seizure type, history, frequency, precipitating factors, treatment and EEG findings for an RRB disability claim based on epilepsy.
Updated provider statement of diagnosis, findings, response to treatment and estimated return-to-work date that the RRB requires before paying continuing sickness benefits.
Lets a relative or other person sign RRB sickness-benefit claims for an employee whom a health care provider certifies is incapable of handling them.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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The treating or examining physician or other medical source. The HA-1151, Medical Source Statement of Ability to Do Work-Related Activities (Physical), is a 7-page form on lifting, sitting, standing, manipulation, postural and environmental limits. Its mental counterpart, the HA-1152, rates understanding, interacting, concentrating and adapting from none to extreme. Both go back to the hearing office or DDS that sent them, or through the claimant's representative.
It depends on the form. For a consultative examination, the state DDS pays the examiner under its CE fee schedule. For the SSA-787, SSA states it cannot compensate the provider. The Railroad Retirement Board asks that its SI-7 supplemental statement be supplied without expense to the RRB, and treats the fee for a G-260 seizure report as a matter between the applicant and the physician unless the RRB contracts for the exam.
The SSA-787, Medical Source Opinion of Patient's Capability to Manage Benefits, asks whether an adult beneficiary can manage or direct the management of Social Security or SSI payments. SSA uses the answer to decide between direct payment and a representative payee. The form is not on ssa.gov; SSA mails it pre-filled per case, and the treating physician or other medical source mails it back in the enclosed envelope.
The SI-1b, Statement of Sickness, the last page of the RRB's SI-1a/SI-1b packet. A physician, dentist, psychologist, chiropractor, PA-C, nurse practitioner, or certified nurse-midwife for pregnancy certifies the diagnosis, the period the employee cannot work and the expected return date. It is a flat PDF returned to the patient for mailing to the RRB. For continuing benefits the RRB sends the SI-7 and pays nothing further until it comes back.