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Social Security Administration ssa.gov Missing Disability Report and Medical Authorization Form Yahoo / va ^CH MI 356 Do Not Reply ssa.gov From: ch.mi.356.do.not.reply@ssa.gov To: mummx4@yahoo.com Fri, Jan 24, 2014 at 8:02 AM THANK YOU FOR COMPLETING PART ONE OF THE DISABILITY APPLICATION. WE STILL NEED A DISABILITY REPORT AND MEDICAL AUTHORIZATION FORM FROM YOU. We have received your disability application. What you have submitted is only part of your application process. We also need the disability report and medical authorization form that gives us permission to contact your doctors, clinics, hospitals or other sources of information about your condition. WHAT YOU NEED TO DO To complete the disability report, click on this link: http://www.socialsecurity.gov/adultdisabilityreport. Please read the helpful hints for completing the internet disability report at the end of this message. The medical authorization form, SSA-827, is included in the adult disability report. You can choose the option to electronically sign the SSA-827 medical release form when completing the disability report. If you choose that option, the “click and sign” action at the end of the report submits the SSA-827 to Social Security electronically. If you do not choose the electronic option, you will need to print, sign and return the medical release form available at this link: http://www.socialsecurity.gov/online/ssa-827.pdf. In the top right section, where it asks for your SSN, please write your social security number. Then, be sure to sign the form near the bottom left of the page and complete your address/contact information. You do not need to complete any other information. WITHOUT THIS INFORMATION YOUR CLAIM CANNOT BE PROCESSED. HOW TO CONTACT US... Address: Social Security Administration 1115 Washington Avenue Bay City MI 48708 Phone: 866-366-4924 Helpful Hints for Completing your Internet Report Be sure to print your reentry number. This will allow starting, stopping, and resuming your application at any time. Keep a record of it for your interview with Social Security. Don’t use abbreviations when listing your disabling condition. Spell it out (i.e. high blood pressure instead of HBP). Don’t use punctuation in addresses, or names of physicians, hospitals, etc. Skip the commas, and periods as they tend to cause problems. If you see a number of doctors at the same clinic, enter the clinic name in the section, “Medical History – About Your Hospitals or Clinics,” rather than listing each doctor in the first section. When Social Security requests records from a clinic, they will get the records from all of your doctors. In the section, “Medical History – About your Doctors and Other Medical Professionals,” only list doctors who practice independently from a hospital or clinic. In the section, “Work/Education – About Your Jobs,” list the types of work you have done, not necessarily each job (i.e. if you worked as a waitress at six different restaurants between 1999 and 2005, show as one job entry with that date range). If you list a doctor in the “medication” or “medical tests” section, be certain they are included in the prior sections (either the About Your Doctors… or About Your Hospitals…sections). If the prescribing doctor is affiliated with a clinic previously mentioned, you just list the clinic as the prescribing doctor. List only the doctors/clinics and tests that are related to the disability. For example, if the disability is depression, we don’t need to know about an eye exam. DO NOT RESPOND TO THIS MESSAGE USING E-MAIL Our Internet services are a secure method of doing business; however, e-mail systems are not secure. To protect your Social Security number and other private information we do not conduct specific business using e-mail. For a full examination of our Online Privacy Policy, please visit: Social Security Online Privacy Policy Reply, Reply All or Forward