Appendix B: Desk Guide – Forms Used in the DAP Process

Following is a list of DAP and SSA forms which may be needed during each step of the DAP process

The DAP Referral Form (PA 731) is used during each step of the process as a means of communication between the DAP advocate and SSA, and the DAP advocate and the CAO worker.

I. Initial Referral to DAP

Completed by the CAO Worker

PA 731	DAP Referral Form
PA 736	DAP Contact Card

II. Initial SSI/SSDI Application

Completed by the DAP Advocate

PA 735	Client Appointment Letter
PA 734	DAP Disability Report
PA 736	DAP Contact Card
PA 731	DAP Referral Form
SSA 1696-U4	Appointment of Representative Form
PA 4	Authorization for Release of Information Form
PA 732	Data Entry Form
PA 601-N	Narrative

III. Reconsideration

Completed by the DAP Advocate

PA 736	DAP Contact Card
PA 734	DAP Disability Report
PA 4	Authorization for Release of Information Form
PA 731	DAP Referral Form
PA 737	DAP Termination Letter
PA 749	MRT Transmittal
SSA 1696-U4	Appointment of Representative Form
SSA 561-U2	Request for Reconsideration
SSA 3441-F6	Reconsideration Disability Report Form
SSA 827	Authorization to release Medical information (2 copies)

SSA Forms Which May Be Sent to the MRT

SSA 4268-C4 SSA	Denial Notice (should always be sent)
SSA 5002	Record of Phone Contacts
SSA 4734-U8 or SSA 4734-F4	Mental or Physical Residual Functional Capacity Assessment
SSA 2506-BK	Psychiatric Review Technique
DD 164	Psychiatric Activities Assessment
SSA 831-U3	Disability Determination and Transmittal
SSA 3368-BK	Disability Report
SSA 3369-F6	Vocational Report
SSA 3820	Children’s Assessment Form

IV. Administrative Law Judge Hearing

Completed by the DAP Advocate

HA 501-U5	Request for Hearing
SSA 827	Authorization to release Medical information (2 copies)
SSA 1696-U4	Appointment of Representative Form
PA 731	DAP Referral Form
PA 1579	Referral to Legal Services

V. Appeals Council Review

Completed by the DAP Advocate

HA 520-U5	Request for Review of Hearing Decision
PA 731	DAP Referral Form

VI. Appeal to United States District Court

Completed by the DAP Advocate

SSA 1696-U4	Appointment of Representative Form
PA 731	DAP Referral Form

Issued June 13, 2003; reviewed March 16, 2012