Download Forms

Below you will find a list of important forms that I refer to many times within this website.  These include a new client questionnaire, a form that you use to appoint me as your attorney, a fee contract for my services, and a statement of earnings form that you will have to send to SSA in order to request your earnings records.

New Client Social Security Questionnaire

When applying for Social Security, you have to provide information about your work history, your disabling condition and your medical treatment.  If you need assistance with organizing your information, use our New Client Social Security Questionnaire, available in Adobe PDF format.  Download our questionnaire in MS Word Format here.  Once you have filled out the form you can submit it to us in person, fax to (770)393-0240, or mail it to us.

Appointment of Representative Form

In order for our law firm to represent you, please fill out a Appointment of Representative form.  This form is available to download in Adobe PDF format.

Attorney-client fee contract

we handle the majority of our Social Security cases under a contingency fee.  In other words, you will only have to pay if we win a lump sum payment for you.  Download and review our Attorney-client fee contract here.  Keep in mind, that no attorney-client relationship is formed until both you and one of our lawyers agree to the representation and both sign the fee contract and the Appointment of Representative form.

When we accept a case, we will mail a confirmation letter to confirm our representation including copies of the fee agreement and Appointment of Representative forms signed by both you and one of our lawyers.

Deadlines are very tight for filing appeals and other documents with the Social Security Administration, so, please do not assume that we will automatically pursue any kind of action on your behalf unless you receive written confirmation that we are actually representing you.

Statement of Earnings and Benefits

Make sure that you use this Statement of Earnings and Benefits form to request for a copy of your earnings record from Social Security.  This record will include a calculation of the amount of money you would potentially receive in payments on a monthly basis if you should retire or become disabled.

Click to download SSA-7004 – simply fill out the form and mail it to:

Social Security Administration
P.O. Box 7004
Wilkes Barre, PA 18767-7004