Disability Report Form Templates

Use this form if you are an adult and are claiming disability benefits. You can fill out the form yourself or have a representative help you out. It can be any person who is aware of your health issues, but it cannot be your doctor.

This form is used for reporting a disability in the state of California. It is typically completed by a physician to provide information about an individual's disability and its impact on their ability to work or perform daily activities. The report is often required for various disability benefits or accommodations.

This form is used for reporting disability status in the state of Minnesota. It helps individuals provide information about their disability to the appropriate authorities.

This form is used for reporting the termination of temporary total disability (TTD) or temporary partial disability (TPD) in the state of Indiana.

This form is used for reporting work ability in the state of Minnesota. It is used to assess an individual's ability to perform job-related tasks and determine their eligibility for certain benefits or accommodations.

Use this form to contest a decision regarding disability benefits by providing new information on your or the claimant's impairment.

This form is used for reporting extended disability in New Hampshire.

This form is used for the attending physician in New York to provide a report on a patient's medical condition.

This form is used for reporting medical information related to a disability in order to make a decision on disability benefits in Washington state.

This form is mailed to a disabled beneficiary or their representative by the Social Security Administration (SSA) to update their information including information about the treatment they received in the past two years.

This form is used for reporting disabilities to the Washington State Department of Social and Health Services (DSHS). It is available in both English and Tigrinya languages.

This form is used for completing an incapability assessment report in British Columbia, Canada.

This form is used for physicians in New York City to report on a patient's disability. It helps provide documentation for disability benefits and accommodations.

This form is used for doctors in New York to report on the patient's Maximum Medical Improvement (MMI) and Permanent Partial Impairment (PPI).

This form is used for reporting disabilities in the state of Washington. It is available in the Oromo language.

This document is a disability report form used in Washington for individuals who speak Haitian Creole. It assists in providing information about an individual's disability for the purpose of determining eligibility for disability benefits.

This document is used for reporting disabilities in Washington state. It is specific to individuals who speak Persian.