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NOTE: When applicable, this form is to be completed
and used with form, CD9600.CALIFORNIA DEPARTMENT OF EDUCATION
Child Development Division
Form CD9606, (Rev. June 2015)Full Day ProgramSTATEMENT
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How to fill out statement of incapacity

How to fill out statement of incapacity
01
Step 1: Obtain the statement of incapacity form from the appropriate authority or website.
02
Step 2: Fill out your personal information, including your name, address, and contact information.
03
Step 3: Provide the details of your incapacity, such as the medical condition that is preventing you from performing daily activities.
04
Step 4: Include any supporting documents or medical records that can substantiate your incapacity claim.
05
Step 5: Sign and date the statement of incapacity form.
06
Step 6: Submit the completed form to the relevant authority or organization.
07
Step 7: Follow up with the authority or organization to ensure that your statement of incapacity has been received and processed.
Who needs statement of incapacity?
01
Statement of incapacity may be needed by individuals who are unable to carry out their usual daily activities due to a physical or mental condition.
02
This can include individuals who are temporarily incapacitated, such as those recovering from surgery or illness, as well as individuals with chronic disabilities or medical conditions.
03
The statement of incapacity may be required for various purposes, including accessing disability benefits, requesting workplace accommodations, or establishing eligibility for certain medical treatments or services.
04
It is recommended to consult with the relevant authority or organization to determine the specific requirements and purposes for which a statement of incapacity is needed.
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What is statement of incapacity?
A statement of incapacity is a legal document declaring an individual's inability to perform certain duties or tasks, typically due to health or medical reasons.
Who is required to file statement of incapacity?
Individuals who are unable to manage their responsibilities due to incapacity, including caregivers or legal representatives, are often required to file a statement of incapacity.
How to fill out statement of incapacity?
To fill out a statement of incapacity, you typically need to provide personal information, details about the nature of the incapacity, and any necessary medical documentation as required by the relevant authorities.
What is the purpose of statement of incapacity?
The purpose of a statement of incapacity is to formally recognize an individual's inability to perform certain functions, allowing for the management of their affairs by legal representatives or caregivers.
What information must be reported on statement of incapacity?
Information that must be reported includes the individual's personal details, specifics regarding the incapacity, medical assessments, and the contact information of the representative if applicable.
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