Article Structure
The SSA-827 form is a crucial document utilized by the Social Security Administration (SSA) to obtain necessary information about an individual's health and functional capacity. This authorization form enables individuals to permit the release of their medical, educational, and other pertinent records that are essential for assessing eligibility for Social Security benefits. It encompasses a wide array of information including medical records related to physical and mental health conditions, details about substance abuse, and educational evaluations that can provide insight into an individual's ability to perform daily tasks and manage work responsibilities. The request extends to various sources such as hospitals, clinics, educational institutions, and even personal acquaintances who may have knowledge of the individual's condition. All information collected will assist the SSA in determining whether a claimant meets the criteria for disability benefits and their capacity to handle their finances. The authorization is valid for twelve months, and individuals retain the right to revoke it at any time, ensuring control over their personal information. Understanding the importance of the SSA-827 and its implications can empower individuals to navigate the claims process with confidence.
Ssa 827 Example
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Whose Records to be Disclosed |
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NAME (First, Middle, Last, Suffix) |
SSN
Birthday (MM/DD/YYYY)
AUTHORIZATION TO DISCLOSE INFORMATION TO
THE SOCIAL SECURITY ADMINISTRATION (SSA)
** PLEASE READ THE ENTIRE FORM, BOTH PAGES, BEFORE SIGNING BELOW **
I voluntarily authorize and request disclosure (including paper, oral, and electronic interchange):
OF WHAT All my medical records: also education records and other information related to my ability to perform tasks. This includes Specific permission to release:
1.All records and other information regarding my treatment, hospitalization, and outpatient care for my impairment(s) including, and not limited to:
•Psychological, psychiatric or other mental impairment(s) (excludes "psychotherapy notes" as defined in 45 CFR 164.501)
•Drug abuse, alcoholism, or other substance abuse
•Sickle cell anemia
•Records which may indicate the presence of a communicable or noncommunicable disease; and tests for or records of HIV/AIDS
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2.Information about how my impairment(s) affects my ability to complete tasks and activities of daily living, and affects my ability to work.
3.Copies of educational tests or evaluations, including Individualized Educational Programs, triennial assessments, psychological and speech evaluations, and any other records that can help evaluate function; also teachers' observations and evaluations.
4.Information created within 12 months after the date this authorization is signed, as well as past information.
FROM WHOM
•All medical sources (hospitals, clinics, labs, physicians, psychologists, etc.) including mental health, correctional, addiction treatment, and VA health care facilities
•All educational sources (schools, teachers, records administrators, counselors, etc.)
•Social workers/rehabilitation counselors
•Consulting examiners used by SSA
•Employers, insurance companies, workers' compensation programs
•Others who may know about my condition (family, neighbors, friends, public officials)
THIS BOX TO BE COMPLETED BY SSA/DDS (as needed). Additional information to identify the subject (e.g., other names used), the specific source, or the material to be disclosed:
TO WHOM |
The Social Security Administration and to the State agency authorized to process my case (usually called "disability determination |
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services"), including contract copy services, and doctors or other professionals consulted during the process. [Also, for international |
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claims, to the U.S. Department of State Foreign Service Post.] |
PURPOSE |
Determining my eligibility for benefits, including looking at the combined effect of any impairments that by themselves would not meet SSA's |
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definition of disability; and whether I can manage such benefits. |
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Determining whether I am capable of managing benefits ONLY (check only if this applies) |
EXPIRES WHEN This authorization is good for 12 months from the date signed (below my signature).
•I authorize the use of a copy (including electronic copy) of this form for the disclosure of the information described above.
•I understand that there are some circumstances in which this information may be redisclosed to other parties (see page 2 for details).
•I may write to SSA and my sources to revoke this authorization at any time (see page 2 for details).
•SSA will give me a copy of this form if I ask; I may ask the source to allow me to inspect or get a copy of material to be disclosed.
•I have read both pages of this form and agree to the disclosures above from the types of sources listed.
PLEASE SIGN USING BLUE OR BLACK INK ONLY |
IF not signed by subject of disclosure, specify basis for authority to sign |
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INDIVIDUAL authorizing disclosure Signature |
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Guardian |
Other personal representative |
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(explain) |
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(Parent/guardian/personal representative sign |
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here if two signatures required by State law) |
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Date Signed |
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Street Address |
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Phone Number (with area code) |
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WITNESS |
I know the person signing this form or am satisfied of this person's identity: |
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Signature |
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IF needed, second witness sign here (e.g., if signed with "X" above) |
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Phone Number (or Address)
Phone Number (or Address)
This general and special authorization to disclose was developed to comply with the provisions regarding disclosure of medical, educational, and other information under P.L.
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Explanation of Form
"Authorization to Disclose Information to the Social Security Administration (SSA)"
We need your written authorization to help get the information required to process your claim, and to determine your capability of managing benefits. Laws and regulations require that sources of personal information have a signed authorization before releasing it to us. Also, laws require specific authorization for the release of information about certain conditions and from educational sources.
You can provide this authorization by signing a form
You have the right to revoke this authorization at any time, except to the extent a source of information has already relied on it to take an action. To revoke, send a written statement to any Social Security Office. If you do, also send a copy directly to any of your sources that you no longer wish to disclose information about you; SSA can tell you if we identified any sources you didn't tell us about. SSA may use information disclosed prior to revocation to decide your claim.
It is SSA's policy to provide service to people with limited English proficiency in their native language or preferred mode of communication consistent with Executive Order 13166 (August 11, 2000) and the Individuals with Disabilities Education Act. SSA makes every reasonable effort to ensure that the information in the
Privacy Act Statement
Collection and Use of Personal Information
Sections 205(a), 223(d), and 1631(d) of the Social Security Act, as amended, allow us to collect this information. Furnishing us this information is voluntary. However, failing to provide all or part of the information may prevent us from making an accurate and timely decision on your claim that could result in a denial or loss of benefits.
We will use the information you provide to determine your eligibility or continuing eligibility for benefits, and your ability to manage any benefits that you currently receive.
We may also share your information for the following purposes, called routine uses:
1.To State audit agencies for auditing State supplementation payments and Medicaid eligibility considerations;
2.To third party contacts where necessary to establish or verify information provided by representative payees or payee applicants; and
3.To Federal, State or local agencies for administering cash or
In addition, we may share this information in accordance with the Privacy Act and other Federal laws. For example, where authorized, we may use and disclose this information in computer matching programs, in which our records are compared with other records to establish or verify a person's eligibility for Federal benefit programs and for repayment of incorrect or delinquent debts under these programs.
A list of additional routine uses is available in our Privacy Act System of Records Notices (SORNs)
Paperwork Reduction Act Statement
This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control number. We estimate that it will take about 10 minutes to read the instructions, gather the facts, and answer the questions.
SEND OR BRING THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. You can find your local Social Security office through SSA's website at www.socialsecurity.gov. Offices are also listed under U. S. Government agencies in your telephone directory or you may call Social Security at
to our time estimate to this address, not the completed form.
Form Characteristics
| Fact Title | Description |
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| Purpose of the Form | The SSA-827 is an authorization form that allows the Social Security Administration (SSA) to disclose necessary information for determining eligibility for benefits. |
| Validity Period | This authorization is valid for 12 months from the date it’s signed, allowing the SSA to gather relevant medical and educational records during this time frame. |
| Types of Information | It enables the disclosure of various types of information, including medical records, educational evaluations, and treatment history related to disabilities and health impairments. |
| Sources of Information | Any medical or educational entity, such as hospitals, schools, or private practitioners, can be asked to release information regarding the individual's condition. |
| Legal Compliance | The form is developed under laws including HIPAA and FERPA, ensuring compliance in handling personal health and educational information. State laws may also apply based on individual circumstances. |
Guidelines on Utilizing Ssa 827
Once you complete the SSA-827 form, your next step will involve submitting it to your local Social Security Administration (SSA) office. This step is vital for ensuring that the SSA receives the necessary information to process your claim effectively. Here's how you can fill out the form properly.
- Obtain the Form: Download or print the SSA-827 form from the SSA website or obtain it from your local SSA office.
- Fill in Personal Information: Start by entering your full name, Social Security number (SSN), and date of birth in the designated sections.
- Authorize Information Disclosure: Carefully read the section authorizing the disclosure of your medical and educational records. Make sure you understand what information will be shared.
- Specify Information to be Disclosed: Check all relevant boxes to indicate the types of information you are authorizing to be disclosed. This should include medical records, educational assessments, and any other relevant documentation.
- Identify the Sources: List all sources from whom you are requesting information, such as hospitals, schools, and healthcare providers.
- Specify Recipients: Clearly indicate that the information is to be shared with the SSA and any other authorized agencies pertinent to your case.
- Indicate Purpose: Specify the purpose of the authorization, which is to assess your eligibility for benefits and your ability to manage them.
- Sign the Form: Use blue or black ink to sign the form, confirming your authorization. If someone else is signing on your behalf, explain their authority to do so.
- Provide Contact Information: Fill in your current address and phone number, so the SSA can reach you if necessary.
- Witness Signature: If needed, have a witness sign the form to confirm your identity.
- Review: Go through the form again to ensure all fields are completed accurately and legibly.
- Submit the Form: Once everything is filled out correctly, submit the completed form to your local SSA office. You can find your office location on the SSA website or through a quick phone call.
What You Should Know About This Form
What is the purpose of the SSA-827 form?
The SSA-827 form is used to authorize the disclosure of personal information necessary for the Social Security Administration (SSA) to process your claim. This includes your medical records, educational records, and other relevant information that affects your ability to work and perform daily activities.
Who needs to fill out the SSA-827 form?
Any individual applying for Social Security disability benefits or appealing a decision must fill out the SSA-827 form. This process allows the SSA to collect information from various sources about your impairments or disabilities.
How long is the SSA-827 authorization valid?
The authorization provided by the SSA-827 form is valid for 12 months from the date you sign it. Make sure to monitor the expiration to avoid any interruption in processing your claim.
What type of information can be disclosed using the SSA-827 form?
The SSA-827 form allows for the release of comprehensive information, including: - Medical records regarding physical or mental impairments. - Educational evaluations and observations. - Information from family, friends, or caretakers about your condition. All this information helps SSA assess your eligibility for benefits.
Who can provide the information needed for the SSA-827 form?
Any medical professional or educational source can provide the requested information. This includes hospitals, clinics, schools, insurance companies, and mental health facilities. Additionally, personal acquaintances who are familiar with your condition may also share relevant details.
Can I revoke the SSA-827 authorization once it is signed?
Yes, you can revoke your authorization at any time. To do so, you need to submit a written statement to the SSA and inform any information sources you no longer wish to share your details. However, note that the SSA may still use information disclosed prior to the revocation to make determinations regarding your claim.
What should I do if I need assistance completing the SSA-827 form?
If you require assistance, consider asking a trusted friend or family member for help. You can also contact your local Social Security office for guidance on how to properly fill out the form. They can provide clarity on any specific sections that may be confusing.
Is my information protected when using the SSA-827 form?
Yes, your information is protected under various privacy laws such as HIPAA. The SSA takes confidentiality seriously and utilizes your information solely for the purpose of assessing your eligibility for benefits.
How should I submit the completed SSA-827 form?
Once you complete the SSA-827 form, submit it to your local Social Security office. You can locate the nearest office using the SSA website. It's important to ensure the form is sent promptly to avoid delays in your claim processing.
Common mistakes
Completing the SSA-827 form is a critical step for individuals applying for Social Security benefits. However, many make common mistakes that can hinder their applications. Identifying these pitfalls can help ensure a smoother and more efficient process.
One prevalent mistake is incomplete personal information. Failing to provide your full name, Social Security Number (SSN), and date of birth can delay the processing of your request. Each of these elements is essential for the Social Security Administration (SSA) to accurately identify you and retrieve your records. Double-checking that all personal fields are filled out correctly minimizes confusion and potential rejections.
Another frequent error involves unclear authorization for information disclosure. The SSA-827 requires explicit consent to share various types of sensitive information. Some applicants neglect to specify all the sources from whom they wish the SSA to retrieve information. Incomplete specifications can lead to crucial records being overlooked. It's important to think broadly about all potential sources, including past employers and educational institutions, to ensure a comprehensive review of your case.
Additionally, many individuals do not fully understand the scope of the authorization they are granting. The form allows for the sharing of medical, educational, and other types of information. Failing to recognize that this includes both past and current records can lead to missing important documents that could substantiate a claim. Always read through the entire form to grasp what information might be released on your behalf.
Some applicants forget to check the expiration date of their authorization. The SSA-827 is valid for just twelve months from the date of signing. After this period, the permission to disclose information expires, potentially causing a lapse in obtaining necessary documents. Keeping track of this date ensures that there is no interruption in the flow of information to the SSA.
Finally, individuals often overlook the requirement to sign the form correctly. Signing with the wrong ink color or neglecting to provide a witness signature when necessary can lead to immediate rejection of the form. The SSA specifically requests signatures in blue or black ink, and understanding this requirement can alleviate any delays. Following all instructions meticulously is crucial to a successful application process.
Understanding these common mistakes while filling out the SSA-827 can make a significant difference in the outcome of your Social Security application. By carefully checking your information and ensuring complete, accurate disclosures, you can enhance your chances for a successful claim.
Documents used along the form
The SSA-827 form is an important document used as part of the process for applying for Social Security benefits, particularly for individuals seeking disability results. Along with this form, several other documents serve various roles, such as validating information, providing necessary medical records, or offering insights into an individual’s ability to work and live independently. Each document is essential in building a comprehensive case for eligibility and helps the Social Security Administration (SSA) make informed decisions.
- SSA-16: This is the application for an individual’s Social Security Disability Insurance benefits. It collects information about the applicant's work history and medical conditions to evaluate eligibility.
- SSA-3373: Known as the Function Report, this document asks individuals to describe their daily activities and how their impairments impact their ability to carry out basic tasks. It provides the SSA with first-hand insights into the applicant's functional limitations.
- Form 8270: This is a Release of Information form specific to mental health records. Individuals must sign this form to authorize disclosure of sensitive mental health information, which can play a significant role in the evaluation process.
- Medical Records: These consist of comprehensive documentation from healthcare providers detailing the treatment and diagnosis of the applicant's medical conditions. They are crucial for substantiating the claims made in SSA applications.
- Education Records: These records, including report cards and Individualized Education Programs (IEPs), provide information on an applicant's educational history and any learning or developmental disabilities, informing the SSA about the individual’s ability to perform tasks.
- Work History Report: This document is often part of the SSA application process. It lists all employment the applicant has had, detailing job responsibilities and the nature of the work performed, offering context for their disability claims.
- Personal Statements: These statements can be submitted by the applicant or by family members and friends. They describe in detail the individual’s challenges and how disabilities affect everyday living, providing a personal touch to the application.
- Disability Benefit Questionnaire (DBQ): This is often completed by a medical professional to clarify the extent of the applicant's disability. It includes specific criteria that help the SSA assess the severity of the individual’s condition.
- Appeal Forms: If an application is denied, individuals may need to file an appeal. Various forms will be required to give the SSA necessary information to review the case again.
Understanding these documents and their purposes can facilitate a smoother process for applying for Social Security benefits. Each form contributes to the narrative of an individual’s experience and should be completed carefully and accurately to provide the SSA with the most comprehensive information possible.
Similar forms
- HIPAA Authorization Form: Much like the SSA-827, a HIPAA Authorization Form allows individuals to authorize healthcare providers to disclose personal medical information. Both forms require explicit consent and outline the specifics of what information is being shared, from whom, and to whom.
- Consent for Release of Educational Records: Under FERPA, students or their guardians can fill out a consent form similar to the SSA-827 to grant schools permission to release educational records. This ensures that information regarding a student's educational history is shared in a controlled and responsible manner, similar to how the SSA-827 manages medical and personal information.
- Patient Information Release Agreement: This document grants healthcare facilities or professionals the authority to share a patient's medical records with specified third parties, similar to how the SSA-827 works to gather necessary information for disability determinations.
- Authorization for Release of Mental Health Information: Given the sensitivity around mental health records, this form requires explicit consent for sharing such information. Like the SSA-827, it highlights the importance of confidentiality and the need for consent when disclosing specific types of health-related information.
Dos and Don'ts
When filling out the SSA-827 form, it is essential to follow specific guidelines to ensure that the process goes smoothly. Here is a list of things you should and should not do while completing this form.
- Read the entire form before signing. Understanding all sections is crucial to avoid any mistakes.
- Provide complete personal information. Ensure that your name, Social Security Number, and date of birth are accurately entered.
- Specify all the records you authorize for disclosure. Clearly indicate all medical, educational, and other relevant records needed.
- Sign the form using blue or black ink only. This ensures that your signature is clear and official.
- Submit the form to the correct Social Security Office. Ensure you know the location and any additional requirements for submission.
- Keep a copy of the signed form for your records. This will serve as proof of your authorization.
- Request a copy of the form once processed. You have the right to a copy of the authorization you sign.
- Stay aware of the expiration clause. The authorization lasts for 12 months, and you may need to renew it.
- Do not leave any sections blank. An incomplete form can lead to delays in processing your claim.
- Do not make any alterations to the pre-filled information. Always start with a clean version of the form.
- Do not use pencil or any ink other than blue or black. This might render the document unofficial.
- Do not forget to revoke the authorization if necessary. If you no longer want your information shared, promptly notify SSA and your sources.
- Do not sign the form if you do not fully understand it. Seek clarification on any part of the form that is unclear.
- Do not submit the form without reviewing it thoroughly. Double-check for any errors or incomplete sections.
- Do not assume any part of the form can be changed after submission. Changes may require a new authorization to be filled out.
- Do not overlook the witness signature, if required. Depending on the laws in your state, additional verification may be necessary.
By following these guidelines, individuals can ensure that their SSA-827 form is filled out correctly and filed without unnecessary complications, allowing for a smoother process in their claim for benefits.
Misconceptions
Here are seven common misconceptions about the SSA-827 form. Understanding these can help avoid confusion when you need to authorize the release of your personal information.
- The SSA-827 only applies to medical records. Many believe this form is limited to medical documents. In reality, it also includes educational records and information that can assess your ability to perform daily tasks.
- Signing the SSA-827 means you’re giving up your rights. Some individuals think that signing allows unlimited access to their information. However, you are still able to revoke this authorization at any time.
- The SSA-827 is only needed for initial claims. Some assume they only need this form when first applying for benefits. In fact, it may be required during follow-up assessments or evaluations as well.
- You cannot choose which records to disclose. Many people think they must provide all information held by their sources. The SSA-827 allows you to specify what records can be shared, making it more tailored to your situation.
- Your personal information is safe once disclosed. While the SSA takes privacy seriously, there is the possibility of re-disclosure under certain circumstances. Understand how your information may be shared with others.
- Form SSA-827 is too complex to complete. Some find it intimidating and overlook that the form is designed to be straightforward. Most people can understand the requirements with minimal effort.
- You only need to sign the form once. It’s a common misconception that signing is a one-time action. Remember, the authorization is valid for 12 months; you may need to renew it for continued access.
Correcting these misconceptions can lead to a smoother experience when dealing with the Social Security Administration and improve understanding of your rights regarding personal information.
Key takeaways
Here are some key takeaways about filling out and using the SSA-827 form:
- The SSA-827 form is essential for authorizing the disclosure of your medical and educational records to the Social Security Administration (SSA).
- Complete all sections accurately, including your name, Social Security Number, and the purpose of the request.
- The authorization lasts for 12 months from the date you sign the form.
- You must specify all medical sources, educational institutions, and it is best to list details about others who might provide information.
- The form permits the disclosure of various medical conditions, including mental health issues, substance abuse, and HIV/AIDS records.
- Signing the form does not obligate medical providers to share your information; they must comply with legal requirements beforehand.
- You can revoke your authorization at any time by sending a written statement to your local SSA office and your information sources.
Always keep a copy of the signed form for your records. This documentation can be helpful if any issues arise regarding the disclosure of your information.
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