Now that you have submitted your appeal (request for a hearing), Your claim will be sent to the Office of Disability Adjudication and Review (ODAR). You want to do as much as possible to help the hearing office obtain relevant information to support your claim. The following documents will help you as you gather evidence to support your disability claim.
Tip! You can print each of these forms to review later.
Important! Remember to always make backup copies for yourself of any documents that you send to the Social Security Administration or DDS.
Medical provider evaluation forms contain questions that your doctor can answer to document your disability. After the form is filled out, submit it to Disability Determination Services to be included in your claim file.
Scroll down to see all of the available forms.
- Auto Immune Disorder
- Bladder Problem
- Cardiac Arrhythmias Impairment
- Carpel tunnel
- Cervical Spine
- Chronic Fatigue Syndrome
- Chronic Pancreatitis
- Cirrhosis-Liver Disease
- Congestive Heart Failure
- Crohns Colitis
- Diabetes Mellitus
- Hepatitis C
- HIV Infection
- Interstitial Cystitis
- Irritable Bowel Syndrome
- Lumbar Spine
- Lupus (SLE)
- Mental Impairment
- Multiple Sclerosis
- Myasthenia Gravis
- Parkinsons Disease
- Postpolio Sequelae
- Reflex Sympathetic Dystrophy
- Sickle Cell Anemia
- Sleep Disorders
- Thyroid Disorder
- Vestibular Disorder
- Vision Impairment
When you ask your doctor to fill out a Medical Provider Evaluation Form to support your disability claim, you can use this letter to explain to the doctor why you need the medical form filled out.
View and Print: Letter to Doctor
This is a form you can send your doctor to request medical records to be included in your disability claim file.
View and Print: Letter to Doctor
Medical facilities often charge for copies of medical records. Many states have laws that waive or limit the amount that can be charged to get copies of medical records that will be used for Social Security disability or SSI claims. Some states have limits that apply to records requests for any purpose. Some states have no limits at all, which means you may have to pay hundreds of dollars to get your medical records.
The following list contains all of the information we have about state laws regarding fees for medical records. Scroll down to see all of the available states. If your state is not on this list, we do not have information about the law for that state.
Alabama – $1.00 per page for the first 25 pages, not more than 50¢ per page for each page in excess of 25 pages, and a search fee limited to $5.00. The actual cost of mailing can also be charged. X-rays and other special medical records are limited to the actual reproduction costs. Code of Alabama § 12-21-6.1. Effective 8/17/08.
Alaska – No statute limits the costs of copying medical records although many medical providers will provide a copy of records at no charge to a patient.
Arizona – “a reasonable fee for the production of the records.” Arizona Revised Statutes § 12-2295.
Arkansas – The cost of each photocopy, excluding x-rays, is limited to 50¢ per page for the first 25 pages, and 25¢ per page for each additional page. A labor charge of up to $15.00 and the actual cost of postage may also be added for each request. Additional reasonable fees can be charged for retrieval of stored records or narrative statements.AR Code Ann. § 16-46-106, amended 2007.
California – One copy of medical records must be provided free of charge to individuals who have appealed a denial of Medi-Cal, SSI or SSDI and who are pro se or who are represented by a legal aid office. If the appeal is successful, the provider may then bill the patient for the records up to 25¢ per page plus reasonable clerical costs. This provision also applies if a claimant is represented by a private attorney who is not advancing costs. Free copies are not available if the claimant “is represented by a private attorney who is paying for the costs related to the patient’s appeal, pending the outcome of that appeal.” Health and Safety Code § 123110(d), (e) Effective January 1, 2002, modified 1/12/2009.
If a claimant is represented by a private attorney who is advancing costs, the “reasonable cost” of copying medical records is limited to 10¢ per page, or 20¢ if copied from microfilm, plus clerical costs not to exceed $16 per hour. If the records are delivered to the attorney or a private copy service, the custodian must make the records available within five business days and can charge no more than $15. Evidence Code § 1158.
Colorado – A “reasonable cost” is charged. Colorado Statute § 25-1-802 (1)(b)(I).
Regulations: For a representative of the patient, other than a “personal representative (as defined in HIPAA § 164.502(g)), the “ reasonable cost” is defined as $16.50 for the first 10 or fewer pages, 75¢ per page for pages 11-40, and 50¢ per page for every additional page.
If the discharged patient or personal representative (as defined under HIPAA § 164.502(g)) requests the records, a “reasonable cost” is defined as $14.00 for the first 10 or fewer pages, 50¢ for pages 11-40 and 33¢ per page for every additional page. Actual postage and applicable sales tax may also be charged. The per page fee for records copied from microfilm shall be $1.50 per page. 6 Code of Colorado Regulations 1011-1, Chapter 2, Part 184.108.40.206. Effective 3/1/2008.
Connecticut – No charge for health records for Social Security claim or appeal. The request must be accompanied by documentation. The provider shall furnish the health record requested within thirty days of the request. Conn. General Statutes § 20 –7c(d). Hospitals are covered under § 19a-490b.
Delaware — The limits are: $2.00 per page for pages 1 – 10; $1.00 per page for pages 11 – 20; $0.90 per page for pages 21 – 50; $0.50 per page for pages 61 and above. Records related to an application for a disability benefits program need not be prepaid, but payment for all other types of requests may be required before the records are sent. In addition, the doctors may charge the following: The actual cost of postage or shipping when the records are mailed, and the actual cost of reproducing the records when photocopying is not possible (such as radiology films or fetal monitoring strips). 24 Delaware Administrative Code Section 1700.29. Effective 11/1/09.
District of Columbia – There is no code or regulation on this issue.
Florida – Hospitals: $1.00 per page, plus sales tax and actual postage. Nonpaper records (such as microfiche) are subject to a charge not to exceed $2.00. A fee of up to $1 may be charged for each year of records requested. These charges shall apply to all records furnished, whether directly from the facility or from a copy service providing these services on behalf of the facility. Florida Statutes: Title XXIX, chapter 395.3025.
Doctors: Request made by patients and governmental entities: $1.00 per page for the first 25 pages, 25¢ per page for each additional page. Actual cost of reproducing x-rays and other records. Requests made by other entities: Not more than $1.00 per page. Rule 64B8-10.003, Florida Administrative Code. Amended 3/9/2009.
Georgia – O.C.G. §31-33-3(a), which sets out the fee schedule for providing copies of medical records, “shall not apply to records requested in order to make or complete an application for a disability benefits program.”
These provisions do not apply to psychiatric, psychological, or other mental health records of a patient. § 32-33-4. Note that some representatives have been charged fees for copies of medical records, when providers say this section is not applicable. The statute may be ambiguous.
Hawaii – “Reasonable costs incurred by a health care provider in making copies of medical records shall be borne by the requesting person.” No special provision for Social Security claimants. Hawaii Revised Statutes § 622-57(g).
Idaho – There is no statute or regulation on this issue.
Illinois – The cost for copying medical records for Social Security claims in 2013 is a handling charge of $25.99 plus 97¢ per page for pages 1-25, 65¢ per page for pages 26-50 and 32¢ per page for any pages after that, plus actual shipping costs. The cost for copying microfiche is $1.62 per page. In 2011 the costs were $24.81 handling charge plus 93¢ per page for pages 1-25, 62¢ per page for pages 26-50 and 31¢ per page for any pages after that, plus actual shipping costs. The cost for copying microfiche is $1.55 per page. 735 ILCS 5/ Art. VIII, Part 20, effective August 2001, with the annual adjustment of copying fees as required under 735 ILCS 5/8-2006When available and requested by the patient, records produced in an electronic format must be provided at 50% of the paper copy rate. Public Act 95-480, effective August 27, 2007.
HIPAA preempts the Illinois rule by prohibiting the provider, and the provider’s copy service, from charging a handling fee to patients or their personal representatives. The prohibition on handling charges does not apply to requests made by the patient’s attorney.
Indiana – The permitted charges for making and providing copies of medical records are set by the Department of Insurance. Title 16, Health and Hospitals.16-39-9-2. The maximum charge is $1.00 per page for the first 10 pages. 50¢ per page for pages 11 through 50. 25¢ per page for pages 51 and higher. An additional labor fee of $20 can be charged. If labor fee is charged, there is no cost for the first 10 pages. Actual copy of mailing is charged. Additional $10 for rush jobs (within 2 days). Additional $20.00 for certified copy. The provider shall consider waiving or reducing charges if (2006 amendments). 760 IAC 1-71-3 General requirements. A provider or medical records company shall consider waiving or reducing the charges if the patient requested the records for his own use and the charge will cause an undue financial hardship on him. 760 IAC 1-71-4 Waiver of charges.
Iowa – There is no law that limits what can be charged to a Social Security claimant for medical records. “A physician may assess a reasonable charge for providing the requested records or reports to either the patient’s attorney or opposing counsel. In the case of medical records, the reasonable charge should include only copying costs and a charge that reflects the actual time spent by the office staff and the physician in reviewing the records and processing the request. (Principles of Cooperation for Attorneys and Physicians, 1993).
Kansas –K.S.A 65-4971(b), which limited copying charges and required the Secretary of Labor to annually adjust the maximum fees that could be charged, was repealed in 2012. There has been no replacement. Without any state guidelines, federal law may govern. Under HIPPA,a covered entitly may impose “reasonable” cost-based fees for copying medical records. Many providers are following the copying charges set for 2012, which were limited to $18.97 for the cost of supplies and labor plus plus $.63 per page for the first 250 pages, and $.45 per page thereafter. (Effective January 2012 for non-workers’ compensation medical records. In 2011 the maximum charge was $18.40 for the cost of supplies and labor; 61¢ per page for the first 250 pages and 44¢ per page for additional pages. In 2010 the maximum charge was $18.11 for the cost of supplies and labor; 60¢ per page for the first 250 pages and 43¢ per page for additional pages. Providers may charge for the reasonable cost of all duplications which cannot be routinely duplicated on a standard photocopy machine. The fees may be adjusted each year based on the all-items CPI and will be published by the Department of Labor. K.S.A. 65-4971.
Kentucky – Any patient is entitled to one free copy of his medical records, upon written request. KRS § 422.317. http://www.lrc.ky.gov/KRS/422-00/317.PDF The patient may, by written request, direct release of this information to his or her attorney or authorized representative. Any additional copies will incur a maximum charge of $1.00 per page. Copy charges are limited to 50¢ per page for persons with workers’ compensation claims. KRS § 342.035. No specific statute applicable solely to Social Security claimants. Effective 7/96.
Louisiana – The cost for copies of medical records for a claim for Social Security disability or SSI benefits “shall not exceed 50¢ per page for the first five pages, and 25¢ for each additional page except that the amount due shall not be less than the amount paid by the Department of Social Services for such copies.” The copy of the record should be provided in a reasonable time, not to exceed fifteen days. R.S. 46:18. Effective August 15, 2003.
Maine – Reasonable costs incurred by the hospital in making and providing copies of medical records and additions to medical records must be borne by the requesting person and the hospital may require payment prior to responding to the request. The charge for copies of records may not exceed $10 for the first page and 35¢ for each additional page. Maine Statutes [2003, c. 418, §1 (amd).] Title 22 Chapter 401 § 1711, “Patient access to hospital medical records”.
Maryland – A preparation fee of no more than $22.18 (which may not be charged to patients), plus a fee of no more than 73¢ per page, plus the actual cost of shipping and handling. (www.medchi.org 2009). This is calculated based on an annual adjustment using the CPI. Code of Maryland, Health-General § 4-304(c). The Maryland State Medical Society has stated that HIPAA prevents medical providers from charging the preparation fee to individuals, but may charge the copying and postage fee.
Massachusetts – Hospitals or clinics: Existing medical records should be provided free of charge for SSI or SSD applicant by hospitals, clinics, health stops and copying services. MGLA. ch. 111 § 70. Private practitioners cannot charge for copying existing medical records for a claim or appeal under the Social Security Act. This includes physicians, surgeons, therapists, dentists, nurses, psychologists, and podiatrists. MGLA ch 112, § 12CC. See 243 C.M.R. § 207(13)(b)(1) for the issue of raw notes vs. summaries. Insurance companies may charge a reasonable fee for costs incurred in copying recorded personal information. MGLA ch 175I §§ 8 & 10.
Michigan – Effective April 2004, Section 333.26269 of The Medical Records Access Act, Michigan Public Act of 2004, provides that a “medically indigent” individual may receive one copy of his or her physical medical records at no charge. Section 9(4). This does not apply to mental health providers. A “patient” may not be charged the initial fee for medical records but may be charged other permitted fees. For others, the costs for retrieving and copying medical records are as follows: In 2011, the initial fee is $22.13; ); $1.10 per page for the first 20 pages; 55¢ per page for pages 21 – 50; pages 51 and over: 23¢ per page. 2010, initial fee is $21.95); $1.09 per page for the first 20 pages; 55¢ per page for pages 21 – 50; pages 51 and over: 23¢ per page. These fees may be adjusted to reflect the change in the CPI index.
Minnesota – (d)” A provider or its representative may charge the $10 retrieval fee, but must not charge a per page fee to provide copies of records requested by a patient or the patient’s authorized representative if the request for copies of records is for purposes of appealing a denial of Social Security disability income or Social Security disability benefits under title II or title XVI of the Social Security Act; except that no fee shall be charged to a person who is receiving public assistance, who is represented by an attorney on behalf of a civil legal services program or a volunteer attorney program based on indigency. For the purpose of further appeals, a patient may receive no more than two medical record updates without charge, but only for medical record information previously not provided. For purposes of this paragraph, a patient’s authorized representative does not include units of state government engaged in the adjudication of Social Security disability claims.”
MN Statute 144.292 Subd 6(d) (2007). (Replaces MN Statute Section 144.335.)
Mississippi – The cost for providing copies of medical records to the patients or their representatives is limited to $20.00 for pages 1 – 20, $1.00 per page for the next 80 pages, 50¢ per page for all pages thereafter. An additional 10% of the total charge may be added for postage and handling. A $15.00 retrieval fee may be charged if the medical records are stored in archives at a location off premises. A physician shall charge “normal, reasonable and customary charges” for a deposition related to a patient that the physician is treating or has treated. Mississippi Statutes, Civil Practice and Procedure § 11-1-52. Effective July 1, 2004.
Missouri – Effective February 1, 2013 the maximum fees for copy medical records is $22.82 plus $0.53 per page for the cost of labor and supplies for copies provided in paper form. An additional $21.36 may be charged if records are maintained offsite. If copies are provided in digital format, the maximum fee is $5.24 plus $.053 per page or $26.71 total, whichever is less . The base rate, revised in 2011, is $21.36 plus $.50 per page for copies. In February 1, 2010, the handling fee was set at $20.65 plus $0.49 per page . Missouri Revised Statutes Section 191.227. As of 2002, effective February 1st of each year, these costs are increased or decreased based on the annual percentage change in the CPI-U.
Montana – Limits charges to 50¢ per page for copying, and $15.00 for searching and handling recorded health care information. MCA §§ 50-16-540, 541. Effective October 1, 1999 (http://data.opi.mt.gov/bills/mca/50/16/50-16-540.htm).
Nebraska – No cost for medical records for Social Security disability claimants from doctors or hospitals. Effective August 28, 1999. Neb. Rev. Stat § 71-8405.http://nebraskalegislature.gov/laws/statutes.php?statute=71-8405
Nevada – No cost to provide medical records for a Social Security disability or SSI claim or appeal, if the request is accompanied by documentation of the claim or appeal. Up to 60¢ per page may be charged for a second copy of the records to support the same claim or appeal. No administrative fee may be charged. Nevada Revised Statutes § 629.061(3). http://www.leg.state.nv.us/Nrs/NRS-629.html#NRS629Sec061
New Hampshire – The charge for copying “shall not exceed $15 for the first 30 pages, or $.50 per page, whichever is greater.” Copies of filmed records, such as x-rays, are provided at a reasonable cost. There is no special rule for Social Security claims. New Hampshire Revised Statutes Title XXX, Chapter 332-1:1 [Unrelated amendments effective 1/1/2010.]
New Jersey – Copies provided by doctors: Cap of $1.00 per page or $100 for the entire record, whichever is less, with a minimum charge of $10.00 permissible. If the record is less than 10 pages, the doctor may charge up to $10.00. If a summary is provided in lieu of the actual records, the cost cannot exceed the cost that would be charged for the actual record. N.J. Administrative Code, Title 13, Chapter 35. 13:35-6.5(c) 4.
Copies provided by hospitals to a patient or the patient’s legally authorized representative: Cap of $1.00 per page or $100.00 for up to 100 pages. 25¢ for each page thereafter, up to a maximum of $200 for the entire record. Additional charges of $10.00 for a search fee and postage. N.J. Administrative Code, Title 8, § 43G-15.3(d).
New Mexico – $2.00 per page for the first 10 one-sided pages. Not more than 20¢ for each page after that. Request must be accompanied by a written verification that a person is applying for, or appealing a denial of, Social Security disability benefits. NMAC 220.127.116.11. (Access to Medical Records by Disability Applicants) Effective February 14, 2001.
New York – The reasonable charge for paper copies shall not exceed 75¢ per page. Access should not be denied solely because of inability to pay. New York Public Health Law § 17.
North Carolina – The maximum fee shall be 75¢ per page for the first 25 pages, 50¢ per page for pages 26 – 100, and 25¢ per page after that. A “reasonable professional fee” may be charged for reviewing and preparing a narrative summary of the patient’s medical record. Minimum fee of $10.00 may be charged. This section applies to claims for personal injury and Social Security disability claims. North Carolina General Statutes, Section 11.3. § 90-411. Effective July 1, 1997.
North Dakota – Health care providers shall provide medical records at a charge of no more than $20.00 for the first 25 pages and 75¢ per page after 25 pages. or in an electronic, digital, or other
computerized format at a charge of $30.00 for the first twenty-five pages and 25¢ per page after 25 pages. (2011 amendment) This charge includes any administration fee, retrieval fee, and postage expense. N.D. Century Code 23-12-14.2. (effective 1999, 8/1/2005). N.D.C.C. § 23-12-14.1 (amended, 2003) provides for free copies only when the records are being transferred from one medical provider to another. There are no special rules for Social Security claims. Some medical records services will provide free copies if the request is accompanied by the SSA denial.
Ohio – No fee for records used in an application for disability benefits if requested by the patient, patient’s personal representative, or an authorized person and the request is accompanied by documentation that a claim has been filed.. Ohio Revised Code 3701.741(C)(1)(e, effective 3/01. H.B. 125 extended this provision, allows an “authorized person” to request the records and clarifies that a patient may request subsequent records and treatment notes and receive one free copy of those as long as the request is not for duplicate records. If the request is made for other reasons or by someone besides the patient or the patient’s personal representative, there will be a search fee and a per page copying fee, subject to change each year. Ohio Revised Code 3701.741, 3701.742.
Oklahoma – Cost of each copy is limited to $1.00 for the first page and 50¢ for each subsequent page. Applies to physicians, hospitals, and other medical professionals and institutions. The cost of mailing may be charged. No additional fees for searching, retrieving, reviewing or preparing medical records. The physician, hospital or other medical professionals and institutions may produce the records in digital form at a cost not to exceed twelve cents ($0.12) per digital page. The cost of x-rays is the lesser of $5.00 or the actual cost of reproduction. 76 Okla. St. Ann. § 19. Amended (costs raised) 2003.
Oregon – A reasonable cost, effective July 2008, is limited to $30 for copying 10 or fewer pages, and 50¢ per page for pages 11 through 50 and 25¢ each additional page, plus postage. There is an additional charge of $5.00 if the request is mailed by first class mail within 7 days of the request. Actual costs of preparing an explanation or summary, if requested. Oregon Administrative Rules. Board of Medical Examiners, Division 12, Chapter 847-012-000(6).
Pennsylvania – Flat fee for copying medical records to support a claim under Social Security in 2013 is $26.70 plus actual postage. Earlier years were: $26.12 in 2012; $25.24 in 2011; $24. in 2010. This fee will be adjusted based each year on the CPI. Title 42 of the Pennsylvania Consolidated Statutes. § 6152.1. See the PA bulletin for 2013 charges.
Puerto Rico – A “reasonable cost”, which shall not exceed 75¢ per page, up to a maximum of $25.00 for the entire record. 24 L.P.R.A. §3049(e).
Rhode Island – No charge for medical records requested by a patient, his or her attorney or authorized representative in Social Security appeals. The records should be provided within 30 days of request. General Law of RI § 23-17-19.1(16).
South Carolina – 65¢ per page for first 30 pages, 50¢ per page for all other pages, plus search fee up to $15.00, plus postage and sales tax. S.C. Code Title 44, Chapter 115. § 44-115-80.
South Dakota – A patient may be required to pay the actual cost of reproduction and mailing. 36-2-16. “The licensee may require before delivery that the patient pay the actual reproduction and mailing expense.”
Tennessee – Hospitals must provide indigent patients or the person’s attorney or authorized representative with one free copy of hospital records to pursue Social Security claims. T.C.A. § 68-11-304(a)(2)(B). A copy of the application or decision must accompany the request for copies. Doctors can charge a flat fee of $20.00 for up to 5 pages and 50¢ for each page over 5 pages. The actual cost of mailing is additional. T.C.A § 63-2-102, effective July 1, 1997. Revised 2010 H.B. 3049. Workers’ Compensation cases are governed by T.C.A § 50-6-204.
Texas – No fee for records used in an application for disability benefits when requested by a patient or former patient, or by an attorney or other authorized representative.Texas Code, Health & Safety § 161.201 -161.204.
Utah – A health care provider “may charge a reasonable fee to cover the health care provider’s costs” not to exceed $20 for locating the records, 50¢ per page for the first 40 pages and 30¢ per page for each additional page. Postage and sales tax may also be charged. Utah Code, 78B-5-618. No special rule for Social Security claimants. Effective 2011.
Vermont – A custodian shall not charge for providing copies of any health care record requested to support a claim or appeal under any provision of the Social Security Act or for any other federal or state needs-based benefit or program. A “custodian” includes a health care provider, a health care facility and a health insurer. T.18, Ch. 221, § 9419, 18 V.S.A. § 9419.
Virginia – When the patient requests a copy of his own records, a “reasonable cost-based fee, which shall include only the cost of supplies for and labor of copying the requested information, and postage” shall be charged. Code of Virginia § 32.1-127.1:03 subsection J. Requests by attorneys or others: costs for copying and mailing are limited to 50¢ per page for each page up to 50 pages and 25¢ per page for the remainder, plus all postage and shipping costs and a search and handling fee not to exceed $10. Copies shall be provided within 15 days of such request. Virginia Code § 8.01-413. http://leg1.state.va.us/
Washington – WAC Title 246, ch. 08, § 400. RCW- 70.02.010(15) allows medical providers to charge fees for searching and duplicating medical records. Such fees cannot exceed: $1.04 per page for the first 30 pages, 79¢ per page for all other pages. An additional $23.00 clerical fee for searching and handling records, and the cost of a regular office visit if the provider personally edits confidential information from the record, as required by statute. July 1, 2011 – June 30, 2013. Earlier charges (7/1/2009 – 6/30/2011): $1.02 per page for the first 30 pages, 78¢ per page for all other pages plus an additional $23.00 clerical fee for searching and handling records.
West Virginia – No fee for search or copying medical records for an indigent claimant or his/her authorized representative to support a claim or appeal under the Social Security Act. A person is considered indigent if he or she is represented by a legal service organization or verifies that the records are requested for purposes of supporting a Social Security claim or appeal and submits “reasonable proof that the person is financially unable to pay full copying charges by reason of unemployment, disability, income below the federal poverty level, or receipt of state or federal income assistance.” A claimant is entitled to one set of copies per provider. Any additional requests for the same records are subject to the regular copying costs of 75¢ per page. West Virginia Code § 16-29-2.
Wisconsin – If a patient or person authorized by the patient requests copies of the medical records for use in appealing a denial of Social Security disability insurance or SSI, the health care provider may charge “no more than the amount that the federal Social Security Administration reimburses the department for copies of patient health care records.” This amount is currently $26.00. Wisconsin Statute 146.83(1f)(d). Effective 2009.
Wyoming – “A patient shall not be denied a summary or copy of a requested medical records because of inability to pay.” “A physician may establish reasonable charges, and charge a patient for the actual costs incurred in responding to a patient’s request for copies.” The costs may include cost of copies, clerical staff and physician’s time in reviewing and summarizing the records. Wyoming Regulations, Chapter 3 Practice of Medicine, §4(e), “Patient access to physician medical records.”
HIPAA – The Privacy Rule permits the covered entity to impose reasonable, cost-based fees. The fee may include only the cost of copying (including supplies and labor) and postage, if the patient requests that the copy be mailed. If the patient has agreed to receive a summary or explanation of his or her protected health information, the covered entity may also charge a fee for preparation of the summary or explanation. The fee may not include costs associated with searching for and retrieving the requested information. See 45 C.F.R. § 164.524.
This is a form you can use to request a statement from your employer to support your disability claim. You can submit this statement to be included in your disability claim file.
View and Print: Employer Statement
This is a form you can use to request a statement from people you believe can support your disability claim. You can submit these statements to be included in your disability claim file.
View and Print: Witness Statement
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