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SSA-827 2012 free printable template

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You can provide this authorization by signing a form SSA-827. Federal law permits sources with information about you to release that information if you sign a single authorization to release all your information from all your possible sources. 475 20 U.S. Code section 1232g FERPA 34 CFR parts 99 and 300 and State law. Form SSA-827 11-2012 ef 11-2012 Use 4-2009 and Later Editions Until Supply is Exhausted Page1 of 2 Explanation of Form SSA-827 Authorization to Disclose Information to the...
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How to fill out SSA-827

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How to fill out SSA-827

01
Start by downloading the SSA-827 form from the Social Security Administration (SSA) website.
02
Fill in the personal information section including your name, Social Security number, date of birth, and address.
03
Indicate the purpose of the consent, specifying that it's for the release of medical records.
04
Provide the names and addresses of the medical providers or facilities that you are authorizing to release information.
05
Specify the types of information you are consenting to be released (e.g., medical history, treatment records).
06
Indicate the right to revoke this consent at any time by stating the relevant provisions.
07
Sign and date the form at the bottom where indicated.
08
Make copies for your records and submit the original form to the SSA or your medical provider.

Who needs SSA-827?

01
Individuals applying for Social Security Disability benefits.
02
Beneficiaries seeking Medicare coverage.
03
Anyone requiring the disclosure of their medical records for SSA processes.

Who needs a Form SSA-827?

Any social security disability payee wishing to authorize and request disclosure of their medical records, educational records, and other information about their ability to perform tasks.

What is Form SSA-827 for?

The form serves a dual purpose in disability claims: (1) it is a written request of the claimant to a medical or another source to release information and (2) it serves as authorization for the claimant’s sources to provide information to the Social Security Administration. These sources include the claimant’s hospitals, doctors, schools, nurses, psychiatric social workers, employers, friends, and family members.

Is the SSA-827 fillable form accompanied by other forms?

No other form is required.

When is Form SSA-827 due?

There is no deadline for submission of the form.

How do I fill out the printable SSA-827 form?

You should fill the “WHOSE Records to be Disclosed” box with your name, your social security number, and your date of birth.

You should check the box before the words “Determining whether I am capable of managing benefits ONLY” only if this applies to you.

You should sign, date, and complete the “INDIVIDUAL authorizing disclosure” box if you are authorizing the disclosure on your own behalf.

If you sign the form on behalf of the other person authorizing disclosure, you should fill the “IF not signed by subject of disclosure” box. Mark the respective checkbox to indicate that a parent of a minor, a guardian, or other personal representative signed the form.

In section “WITNESS”, an individual who knows the person signing the form should sign as a witness and provide his or her phone number or address. If needed, there is a space for a second witness.

Where do I send Form SSA-827?

You should bring or send the form to your local Social Security Office.

Instructions and Help about SSA-827

Welcome to the disability television comm discussion series hosted by Florida disability attorney Walter Rudolph not the third of the disability resolution Orlando based law firm now tonight we're going to be focusing on the completion of an important social security disability form now as always there are no guarantees in life but the more thorough and accurate you are in completing these important forms the better your chances become of being awarded disability benefits while you can always complete all the forms yourself we at disability resolution are available to assist you with this detailed process to ensure that all the necessary information is properly communicated to the SSA I am attorney Walter are not the third of disability resolution, and I'd like to cover completing the Social Security Administration form SSA eight to seven being the authorization to disclose information to the SSA simply put it's a HIPAA or Health Insurance Portability and Accountability Act form okay so the SSA — seven is a forum where you voluntarily authorize the release of your medical records and other supplemental records to the SSA you want this so that they can collect evidence on your claim to determine your eligibility for benefits now in order to complete the SSA — seven form look to the upper right and neatly print or type your first middle and last name with any suffix like junior or the third sort of like my name Walter Ruth not the third immediately beneath your name printer type your social security number followed by your date of birth in month day and full year format you should than read through the SSA eight to seven form to get a full understanding of what it entails or discuss the form with your attorney who explained it to you in detail now do not complete the middle section of the form as the space is for the SSA moving now to the lower section of the form sign the form in front of your witness using blue or black ink date it completes your address and add your phone number your witness can be anyone at least 18 years of age who knows you but remember federal law does not require witness to sign but if a witness does the witness must also provide their address or phone number on the space provided as a side it's always best to have a witness sign your disability documents as to lower the probability of fraud in your behalf additionally do not forget to date the forum after you sign in when the form is completed it must be submitted to the SSA following the instructions on the back of the form or be given to your attorney for error review and admin facts middle to the SSA as a few side notes an 8 to 7 usually lasts around 12 months can be limited by timelines includes material created after its signature and usually covers educational records as well in the event you have any questions or like assistance with the form completion process please feel free to contact me at info at disability resolution calm or 407 279 1754 once again 407 279...

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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.
Online; or. By calling our national toll-free service at 1-800-772-1213 (TTY 1-800-325-0778) or visiting your local Social Security office.
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.
Children filing a claim on their own behalf or individuals with legal authority to act on behalf of a child can use our attestation process to sign and submit the SSA-827 when filing by telephone or in person. This does not apply to children age 12 or old who are still considered a minor under state law.
YOU 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.
You can provide this authorization by signing a form SSA-827. Federal law permits sources with information about you to release that information if you sign a single authorization to release all your information from all your possible sources. We will make copies of it for each source.

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SSA-827 is a form used by the Social Security Administration to authorize the release of medical records and other related health information.
Individuals applying for Social Security benefits or those undergoing a review for existing benefits may be required to file SSA-827.
To fill out SSA-827, provide your personal information, specify the medical providers from whom you are requesting records, and sign the form to authorize the release of your information.
The purpose of SSA-827 is to ensure that the Social Security Administration has access to relevant medical information to make informed decisions regarding benefits.
Information that must be reported includes your personal details, the names of healthcare providers, the types of records requested, and your signature to authorize the release.
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