SSA-827: Authorization to Disclose Information to SSABy starting the medical evidence collection process at this early stage, SOAR case managers are able to collect medical evidence while working on other aspects of the application, and will have time to schedule any necessary exams. Here are some tips for completing the SSA-827: Authorization to Disclose Information to SSA (PDF). Show
Completing the SSA-827
Note: When filing the SSI/SSDI application online, the applicant will be prompted to electronically sign a Medical Release (i.e., electronic version of SSA-827). We recommend completing this online version whenever possible and delivering an original signed paper SSA-827 to your local SSA field office with your complete SOAR application packet. When completing the online medical release form (e827), be sure that the applicant is present with you and clicks to “sign” the e827. See a sample completed SSA-827 here. TN 46 (10-14) CITATIONS: P.L. 104-191 the Health Insurance Portability and Accountability Act of 1996 (HIPAA); 45 CFR parts 160 and 164; 42 U.S.C. section 290dd-2; 42 CFR part 2; 38 U.S.C. section 7332; 38 CFR 1.475; 20 U.S.C. section 1232g the Family Education Rights and Privacy Act (FERPA); 34 CFR parts 99 and300; and State law. The Form SSA-827 (Authorization to Disclose Information to the Social Security Administration (SSA)) is the form we use to obtain medical and non-medical information required to:
NOTE: The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule permits disclosure of all medical records; the Privacy Act protects the information SSA collects. Only claimants residing in Puerto Rico may use Form SSA-827-SP, the Spanish version of the form. To view or print Form SSA-827, see OS 15020.110. To view or print Spanish language instruction for completing the SSA-827, see the SSA-827–SP-INST A. Purpose of Form SSA-827The completed Form SSA-827 serves two purposes in disability claims (and non-disability claims when capability is an issue):
Additional details on the purpose of Form SSA-827 are on page 2 of the form. SSA and the disability determination services (DDS) send the completed Form SSA-827 to sources, including consultative examination sources, with requests for evidence (unless other local arrangements apply). Foreign field offices (FOs) usually obtain a completed Form SSA-827 for U.S. medical sources only. You can find instructions for obtaining evidence from foreign sources in the international agreements. B. Procedures for completing Form SSA-827The following procedures apply to completing Form SSA-827. However, regional instructions for completion may vary due to states’ release requirements. Regional offices (ROs) may provide specific guidance for completing Form SSA-827. 1. WHOSE records to be disclosed boxThe claimant or SSA completes the “WHOSE Records to be Disclosed” box located in the upper right-hand corner of the form. 2. OF WHAT sectionThe OF WHAT section describes the types of information sources can disclose, including the claimant’s medical records, educational records, and other information related to the claimant’s ability to perform tasks. Form SSA-827 includes specific permission to release the following:
Every Form SSA-827 includes specific permission to release all records to avoid delays in processing. Using the form does not imply that the claimant has received treatment for drug abuse, alcoholism, sickle cell anemia, HIV/AIDS, or any other communicable or noncommunicable disease. If State law requires the claimant to affirm his or her informed consent by initialing the white spaces to the left of each category of this section, the claimant must use a paper Form SSA-827 with a pen and ink signature. 3. FROM WHOM sectionThe FROM WHOM section contains potential sources of information including, but not limited to, the following:
4. FROM WHOM boxThe FROM WHOM section contains an area labeled, “THIS BOX TO BE COMPLETED BY SSA or DDS (as needed).” a. Entering specific information in the FROM WHOM boxSSA or DDS may use this area, as needed, to:
b. Claimant restricts Form SSA-827When a claimant requests to restrict Form SSA-827, follow these steps:
5. TO WHOM sectionThe TO WHOM section informs the claimant about the state and federal entities that process the disability claim: the Social Security Administration and the state agency authorized to process the claim (usually the DDS), including contract copy services, doctors, or other professionals consulted during the process. In addition, for international claims, the U.S. Department of State Foreign Service Post is involved. 6. PURPOSE section for non-disability capability claimsAuthorization for the general release of “all records” is still necessary for non-disability claims where the claimant’s capability is an issue. For these claims, in the PURPOSE section, check the box before the statement, “Determining whether I am capable of managing benefits ONLY.” (For procedures on developing capability, see GN 00502.020 and GN 00502.050A.) 7. EXPIRES WHEN sectionThe authorization expires 12 months after the date below the signature of the person authorizing disclosure. For further details about disclosing information, re-disclosing information, and revoking the authorization, see page 2 of Form SSA-827. By signing Form SSA-827:
IMPORTANT: Form SSA-827 must include the claimant’s signature and date of signing. Never instruct claimants to provide an undated Form SSA-827. If the claimant submits an undated Form SSA-827, return it to the claimant for dating. 8. INDIVIDUAL authorizing disclosure boxHave the claimant sign, date, and complete the INDIVIDUAL authorizing disclosure box at the bottom left of Form SSA-827. For more information about signature requirements for Form SSA-827 or for completing this section when the claimant is not signing on his or her own behalf, see DI 11005.056. 9. IF not signed by subject of disclosure boxIf the claimant has not signed Form SSA-827, make sure the appropriate checkbox is marked to indicate that a parent of a minor, a guardian, or other personal representative signed the form. If a personal representative signed the form, explain the relationship to the claimant in the space provided under the checkbox. 10. WITNESS boxWe provided a block in this section for the witness signature, address, and phone number. We provided a second block, to the right of the first block, for the signature of a second witness, if required. When we attest to the claimant’s signature on Form SSA-827, we document the attestation in the witness box see DI 11005.056. If the claimant signs by mark, the witness signature is required and the witness block must be completed. IMPORTANT: If the field office (FO) receives a non-attested Form SSA-827 without the signature of a witness, we continue to process the claim. Do not delay the claim to seek the claimant's witnessed signature unless the claimant signed Form SSA-827 by mark or the FO knows from experience that certain sources require a witnessed signature. What is authorization for the Social Security Administration?SSA and its affiliated State disability determination services use Form SSA-827, "Authorization to Disclose Information to the Social Security Administration (SSA)" to obtain medical and other information needed to determine whether or not a claimant is disabled.
What does individual authorizing disclosure signature mean?INDIVIDUAL authorizing disclosure
The individual must sign and date this authorization, and provide his or her street address, city, state and zip code and telephone number with area code. IF not signed by subject of disclosure, specify basis for the authority to sign.
Where do I send form SSAYOU MUST SIGN, DATE, AND RETURN THE ENGLISH VERSION OF THE SSA-827 TO YOUR LOCAL SOCIAL SECURITY OFFICE TO HAVE YOUR DISABILITY CLAIM PROCESSED. WHOSE Records to be Disclosed - Please provide your first, middle, last name and suffix (if any), your social security number, and your birthdate.
What is a SSN verification release form?Form SSA-89 is titled as an Authorization for the Social Security Administration (SSA) to Release Social Security Number (SSN) Verification. This form is used when certain sorts of business transactions, such as a credit check, must be performed. It is used to verify the social security number of the named individual.
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