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DSSEA22006/16Work Ability and Work History Report for Longterm Care Disability Determination (To be completed for individuals age 18 to 65.)Name: ___Birth Date: ___ /___/___ ID:___DSS Benefit Specialist:___
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Begin by providing accurate personal information, such as your full name, contact details, and identification number.
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Proceed to fill out the sections that require information about your work history, including previous positions, companies worked for, dates employed, and job responsibilities.
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What is work ability and work?
Work ability refers to an individual's capacity to perform work tasks and responsibilities, taking into account their physical and mental health. Work encompasses the activities and responsibilities undertaken by individuals to earn a livelihood.
Who is required to file work ability and work?
Individuals who are receiving certain benefits or are required by law to report their work ability to a governing body, such as an employer or government agency, are required to file work ability and work.
How to fill out work ability and work?
To fill out work ability and work, individuals must provide detailed information about their current health status, job responsibilities, hours worked, and any other required documentation as specified by the receiving authority.
What is the purpose of work ability and work?
The purpose of work ability and work is to assess an individual's fitness for duty, monitor compliance with employment-related regulations, and determine eligibility for benefits or accommodations.
What information must be reported on work ability and work?
The information that must be reported includes personal identification details, medical history related to work capacity, current job role, hours worked, and any relevant changes in circumstances.
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