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Complaint for Review of Social Security Decision

Federal · United States Courts · Effective December 1, 2016

This form is used to start a case in federal court asking the judge to review a decision made by the Social Security Administration regarding disability or Supplemental Security Income. It asks the filer to explain why the court should change the Social Security decision.

Open the official PDFfrom United States Courts

Where this fits in a case

Start a case

Stage: Start a case

This form is used when someone wants to challenge a final decision from the Commissioner of the Social Security Administration in federal court. The filer must submit the form with a filing fee or an application to proceed in forma pauperis.

Either party may file.

Common questions

Who fills out this form?
The form is for the Plaintiff, who is the person filing the complaint. It also has sections for an attorney to fill out if they are representing the person.
What must be included with this complaint?
The complaint must be accompanied by the filing fee or an application to proceed in forma pauperis.
What information must be protected?
The form notes that filed papers should not include a person’s full social security number or full birth date, but only the last four digits of the SSN and the year of birth are allowed.

Revision history

No changes recorded since we started tracking this form on October 9, 2026. The current version took effect December 1, 2016.

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