| How Do I Get the Forms? |
If you call us to apply, we will mail you the forms.
OR you may visit your nearest Social Security Office
OR you can print the forms (see Printing Authorization Forms). We need
your dated original signature on all forms.
IMPORTANT: When you contact us to apply, we will tell you where to
send or bring the forms.
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I'm Applying
for A Child. Are the Forms Different? |
If you need help with any Social Security forms, you can call us toll
free at 1-800-772-1213 or visit your local Social Security office. We'll
be glad to help you.
More information about how to contact us. |
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| Instructions: FORM SSA-827 |
We need your written authorization
to help get the information required to process your claim. The SSA-827
is arranged in several sections that provide the most important items
legally required for an authorization.
Important Note:
This form is NOT an application for disability benefits.
You must contact SSA to apply. These forms are
used in addition to your application to collect information about you
so we can decide if you meet Social Security's definition of disability.
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| What is this Form Used For? |
The Authorization to Release Information will
be used to request medical records from your health care providers and
other people who can provide us with information about your disability.
We will need a separate form for each place or person that will provide
information.
- This form is used to contact your doctors and other health care providers,
and others who will give us information about you to help us decide
your application for disability benefits.
- When you apply, we will give you the forms. But for convenience, they
are available on the Internet.
The "OF WHAT" section has everything needed for
the release of what is considered especially sensitive information, about
mental impairment(s); substance abuse; sickle cell anemia; HIV/AIDS or tests
for HIV or sexually transmitted diseases; and gene-related impairments (including
genetic test results). This specific authorization is routinely included
on the form to speed processing the claim and does not mean that we think
you may have any of these conditions. Item number 3, about educational tests,
usually only applies when the subject of the disclosure is a child. In order
to avoid delays caused by getting more forms signed in the future, we also
ask you to authorize disclosure of information that may result from treatment
after you sign the form. If you have questions regarding this section, or
any other aspect of the SSA-827 call 1-800-772-1213 or contact your local
Social Security office.
The "FROM WHOM" section covers all the sources
we may need to contact to help get information about your claim. We need
an original signed, dated, and witnessed (not photocopied)
form for EACH medical or other source that you listed
on your disability report form(s):
(SSA-454, SSA-782, SSA-3368, SSA-3441, SSA-3820, SSA-3881, HA-4486).
Please include at least 2 extra original, signed, dated, and witnessed
forms. These forms may be used to get information from sources that you
had forgotten about. (For example, if you have 5 sources, we will need
at least 7 SSA-827s). Please do not send us copies of a signed form.
The other sections of the form are fairly self-explanatory.
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| How to Complete the Form? |
- Read the entire form, front and back. The information on the back
explains some more about how the form will be used and explains the
possible consequences of not signing the form. Additional instructions
are also on the form. If you have any questions, please contact us.
- Be sure the name of the person whose records must be disclosed (the
applicant or beneficiary) is written in the upper right corner of the
form, with their own Social Security Number.
- Do not fill in the large empty box in the middle of the form; SSA
will use this space to help the source identify the information we need.
- Do not put a check in the empty block under "PURPOSE" unless
SSA specifically asks you to.
- INDIVIDUAL SIGN" - Sign each form in this block.
- An adult should sign his/her own form.
- An individual can sign with an "X" if necessary.
- If an individual has been declared legally incompetent, his/her
legal guardian or other legally recognized representative should
sign the form.
- If the individual whose information is going to be disclosed is
not the one signing the form, be sure to check the box to the right
that shows that person's authority to sign (parent, guardian, etc.)
and then give proof of that legal relationship to SSA. If the subject
of disclosure is a minor, then a custodial parent, guardian or other
legally recognized representative should sign the form.
- If the subject of the disclosure is age 12 or older but still
considered to be a minor under State law, he or she should sign
the form and the parent, guardian or other legally recognized representative
should sign in the "Parent/guardian sign" area to the
right.
- ALWAYS enter the DATE the form is signed.
- Enter the address and daytime phone number of the individual signing
the form.
- "WITNESS SIGN" - The signature of the individual signing
the forms must be witnessed by at least one other individual. Many sources
will not honor our request unless it is witnessed.
- The witness can be any competent adult (spouse, social worker,
Social Security employee, etc.).
- The witness should sign and provide his or her address information
in case the source wants to confirm the signature.
- A second witness is usually only required if the subject of the
disclosure signs with an "X."
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| Printing Authorization Forms? |
SSA offers forms in Portable Document Format
(PDF). To read and print a PDF publication, you must have the Adobe Acrobat
Reader ® software installed on your computer. You can download the
Adobe Acrobat Reader for no charge. 
Authorization to Release Information Form
(SSA-827) |
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| What to do with the Form? |
Mail it to the Social Security office that is
servicing your claim or bring it with you if you are going into that office.
If you have not yet filed a claim, please contact us about filing an application
for disability benefits. CONTACT SOCIAL SECURITY
NOW.
Other SSA Forms
Disability Report Form Guide
Learn More About Disability Benefits and How
We Decide If You Are Disabled
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www.socialsecurity.gov
