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Form Ssa 454 Bk

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Form SSA-454-BK, Continuing Disability Review Report, is used by the Social Security Administration to re-evaluate an individual and their need for disability income. This form is sent out by the SSA to individuals they believe have medical conditions that have improved. The recipient needs to complete the report in full and attach necessary information from medical professionals to support their need for disability payments.

Form Ssa 454 Bk

Related Documents

Form Ssa-521 › Form Ssa-632-Bk 2009 › Form Ssa-561-U2 ›

What is a SSA 454 BK?

A Form SSA-454-BK is known as a Continuing Disability Review Report. This form will be used by the Social Security Administration to re-evaluate someone who is receiving social security disability benefits. The SSA will send you this form if they believe that your medical condition has improved. This form will require updated information about your condition, and it may ask for more information from your medical professionals.
Be sure to include as much information as possible in order to keep your benefits. You will need to include information about any doctor’s visits or hospitalizations you’ve had since the last Social Security Administration check. Include the names of these doctors and hospitals so that the SSA can double check the information you provided with the provider.
You will also need to include your medications. The Social Security Administration will need to verify that you are taking all your recommended medications prescribed by a doctor. This helps them ensure that you are proactive about your health.

How to complete an SSA 454 BK (Step by Step)

When filling out a SSA-454-BK, you will need to print or write clearly.  You must answer every question.  If you do not know the answer or the question does not apply, indicate that on the form.

To complete a SSA-454-BK, you will need to provide the following information:

  • Section 1 - Information About the Disabled Person
    • Name
    • Social security number
    • Mailing address
    • Phone number
    • Whether you can speak and understand English
    • Whether you used any other names on your medical or educational records in the last 12 months
  • Section 2 - Contacts
    • Friend or relative who knows about medical conditions and can help you with your case
    • Relationship to disabled person
    • Mailing address
    • Daytime phone number
    • Whether the person can speak and understand English
    • Indicate who is completing application and, if someone else, provide their contact information
  • Section 3 - Medical Condition(s)
    • If you are an adult, list physical and/or mental conditions that limit your ability to work
    • If you are completing for a child, list physical and/or mental conditions that limit a child's ability to do the same things as other children the same age
    • Height without shoes
    • Weight without shoes
    • Whether you use an assistive device such as: eye glasses, hearing aids, braces, canes, crutches, walkers, wheelchairs, service animals
  • Section 4 - Medical Treatment
    • Whether you have seen a health care professional or received treatment for any physical conditions in the past 12 months
    • Whether you have seen a health care professional or received treatment for any mental conditions in the past 12 months
    • Who has your medical records for the past 12 months
      • Name of facility or office
      • Name of healthcare professional that treated you
      • Phone number and address
      • Patient ID number
      • Dates of treatments in office, clinic, outpatient facility, emergency room, and overnight hospital stays
      • What medical treatments were treated or evaluated
      • What treatment did you receive for the above conditions
    • Types of tests and dates given: EKG, treadmill, cardiac catheterization, biopsy, hearing test, speech/language test,vision test, breathing test, EEG, HIV test, blood test, X-ray, MRI/CT scan, other
  • Section 5 - Medicines
    • Whether you are taking or haven taken in the past 12 months any prescription or non-prescription medicines
      • Name of medicine
      • Any prescribing doctor
      • Reason for medicine
  • Section 6 - Other Medical Information
    • Whether anyone else has medical information about your physical or mental condition(s) covering the last 12 months
      • Name or organization
      • Phone number
      • Mailing address
      • Contact person
      • Claim number
      • Dates of first contact, last contact, and next contact
      • Reason for contacts
  • Section 7 - Education and Training
    • Whether you have received any education since your last disability decision
    • What year did you last attended school
    • Education received
    • Whether you received any type of specialized job, trade, or vocational training since your last disability decision
      • Name of training facility
      • Phone
      • Mailing address
      • Type of program
      • Date completed
  • Section 8 - Vocational Rehabilitation, Employment, or Other Support Services
    • Since your last medical disability decision, whether you have participated in: an individualized work plan with an employment network under the Ticket to Work Program; an individualized work plan with a vocational rehabilitation agency or any other organization; a Plan to Achieve Self-Support; an Individualized Education Program (IEP) through a school (if a student age 18-21); or any program providing vocational rehabilitation, employment services, or other services to help you go to work.
    • Year you last attended school
    • Name of organization or school
    • Name of counselor, instructor, or job coach
    • Address
    • When you began participating in the program
    • Whether you are still participating in the program
    • What types of services, tests, or evaluations were provided
  • Section 9 - Daily Activities
    • Describe what you do in a typical day
    • Describe any hobbies or interests
    • Whether you have any difficulting doing any of the following activities and explanations: dressing, bathing, caring for hair, taking medicines, preparing meals, feeding self, doing chores, driving or using public transportation, shopping, managing money, walking, standing, lifting objects, using arms, using hands or fingers, sitting, seeing, hearing, speaking, concentrating, remembering, understanding or following directions, completing tasks, getting along with people
  • Section 10 - Work
    • Whether you have worked since the date of your last medical disability decision
  • Section 11 - Remarks
    • Any additional information that was not provided earlier in the report
  • Date report completed

Other considerations

How does social security decide if I am still disabled?

Social Security will conduct a medical disability review every 3 or 5 or 7 years.  When it is time for you to have a review, you will be sent a Continuing Disability Review or a Disability Update Report.  

During the review they will look at the condition or conditions that you were approved for or any conditions that were found to be disabling at the time of your last full medical review. If they find that your conditions are the same or worse, your review will likely pass.  If your conditions have improved, they will consider any other conditions that you developed and decide whether you are now able to work a full-time job.

What to do after sending back review forms

After you send back the review forms, you should ensure that it was received.  Find out if your case was assigned to someone and confirm that they have received all of your records.  If you need to submit any follow up materials, make sure that they go directly to the person who is handling your case.

Appealing

If you are denied, you can appeal the review.  The form to fill out is called a “Request for Reconsideration.”  If you file a “benefit continuation” form within ten days of your denial, you will continue to receive your disability check and Medicaid or Medicare benefits during your appeal.

If you do not wish to request benefit continuation, then you have 60 days to file your appeal.

Troubleshooting

If you have not been seeing a doctor, be honest with Social Security about the reason.  If possible, start going to the doctor now.  It is important to have a doctor fill out a Residual Functional Capacity (RFC) form.  This form shows all the ways that your disability limits you and why you are not able to work.  If you haven’t been seeing a doctor regularly, consider going to one who you have seen in the past and has your records on file and get them to fill out this form for you during your appointment.

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Form Ssa-454-Bk

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Form Ssa-521

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Form Ssa-632-Bk 2009

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Form Ssa-561-U2

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