APPLICATION FOR DEVELOPMENTAL DISABILITY SERVICES State Form 55068 (8-12) Indiana Family and Social Services Administration (IFSSA) Division of Disability and Rehabilitative Services Bureau of Developmental Disability Services * THIS STATE AGENCY IS REQUIRING DISCLOSURE OF YOUR SOCIAL SECURITY NUMBER PER IC 4-1-8-1. THE INFORMATION OBTAINED ON
A residual functional capacity (RFC) form can help you with your Social Security Disability claim at both the initial application phase and the appeal hearing level. It is a good idea to have this form completed by your treating physician at the beginning of your claim for Social Security Disability or SSI.
Form SSA-16 (06-2018) UF Discontinue prior editions Social Security Administration. APPLICATION FOR DISABILITY INSURANCE BENEFITS. Page 1 of 7 OMB No. 0960-0618. I apply for a period of disability and/or all insurance benefits for which I am eligible under Title II and Part A of Title XVIII of the Social Security Act, as presently amended.
Form Approved Exp. Date 09/30/2019. This is an application for a total and permanent disability discharge of your Direct Loan, FFEL, and/or Perkins Loan program loan(s), and/or your Teacher Education Assistance for College and Higher Education (TEACH) Grant Program service obligation. Throughout this application, the words “we,” “us,” and
Return this application to your county licensing office to acquire disability access license plates and/or disability access placards. 2. Fees for disability access parking privileges: $23.00 regular license plate fee for each private passenger automobile; $15.00 regular license plate fee
Child Disability Allowance application form The Child Disability Allowance is a non-taxable, fortnightly payment made to the main carer of a child or young person with a serious disability. It’s paid to recognise the extra care and attention needed for that child.
Check here if this application is for two parking certificates* Check here if this application is for a second parking certificate*Two certificates are not an option if applicant has disability license plates Limit 2 per applicant without disability license plates. DISABLED INDIVIDUAL SECTION . To be completed by or for the person with a disability
Disability Type : Disability By Birth : Pension Card Number : Hospital Treating Disability : Disability Area : Disability Due to : (DD/MM/YYYY) (in Year) (*If yes, please fill in the following details & attach disability certificate) (For example: 30%, 40%, 50%, 60%) Date of Issue : Disability Scheme : Disability Since : Yes* No
Print an Application. Start here to apply by mail or fax. Printable application forms can be mailed to the address or faxed to the number on on each form. Note: Only applications submitted online will get confirmation of receipt.
FORM PA-1 SIDE 1 January 2018 PERSON WITH A DISABILITY PARKING PERMIT APPLICATION FIRST TIME, TEMPORARY & REPLACEMENT PLACARDS STATE OF HAWAII DISABILITY AND COMMUNICATION ACCESS BOARD 2 This form must be taken to a County issuing site. Applicant must present proof of identity. All forms of identification (ID) shall be current or valid.