https://www.ssa.gov/forms/ha-4632.pdf You must complete each box on the form. It does not have to be perfect and you can estimate some of the information if you don’t remember it, but you still have to complete each box. You are filling this out based on updated information, and if you have a “date-last-insured” , you are expected to complete it for the period prior to the date-last-insured. But if you do not have a date-last-insured, you only need to complete it for the most up-to-date, recent period, just prior to the hearing date. Look at your medicine bottles or doctors’ office notes to get the names of your medications and dosage. Look at the date on the medicine bottles to determine the date the medicine was first prescribed. State how many pills you take each day. State the reason for the medication, for example, high blood pressure, diabetes, depression, etc. Finally, the medicine bottle will name the doctor who prescribed the medicine. The doctor’s name must be put on the form. In the box at the bottom of the form, you must list all nonprescription medications you take, even if infrequently. For example, if you take over-the-counter drugs when you have periodic headaches, make sure you list these. If you can’t remember, look in your medicine cabinet at home to see what over-the-counter medicines you bought.