Form Ssa 827 – Fill Out and Use This PDF

Updated: Nov 2, 2026

The Form SSA-827, officially titled "Authorization to Disclose Information to the Social Security Administration (SSA)," serves as a comprehensive authorization for the SSA to access an individual's medical records, educational records, and other information pertinent to determining eligibility for benefits or assessing one's ability to work and perform daily tasks. It requires the voluntary authorization of the person applying for benefits, allowing the SSA and related agencies to retrieve necessary information from a wide array of sources. This form is critical in the process of applying for Social Security benefits, ensuring that the SSA can make an informed decision based on all relevant information. For those looking to navigate the complexities of applying for benefits, understanding and filling out this form accurately is a crucial step. Click the button below to fill out the Form SSA-827.

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Form Ssa 827 PDF Details

In the realm of Social Security benefits, particularly in the context of applying for disability benefits, the Form SSA-827, stands as a crucial piece of documentation. Predicated on the authorization to disclose information to the Social Eecurity Administration (SSA) and other relevant state agencies, this form serves as a voluntary grant of access to a wide array of personal records. From detailed medical and educational records to nuanced information detailing an individual’s ability to undertake day-to-day tasks and employment activities, the SSA-827 permits a thorough evaluation of one's eligibility for benefits. It encompasses permissions to delve into records related to treatments and hospitalizations, covering a broad spectrum of conditions, including mental impairments and substance abuse issues, alongside information on educational performance and vocational assessments. This consent also extends to future records generated within 12 months after the authorization is signed, ensuring that the most current information is available for review. Designed to comply with several federal laws, including HIPAA and FERPA, this form underscores the balance between the need for privacy and the necessity of comprehensive information for benefit determination processes. By dissecting the form’s structure and the depth of consent it entails, potential applicants and their representatives can navigate the Social Security benefits application process with a clearer understanding of how their personal information is used and protected.

Question	Answer
Form Name	Form Ssa 827
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	ssa 827 forms, form ssa 827, authorization any, ssa form 827

How to Fill Out Form SSA-827

Form SSA-827 at a glance

What it is: Form SSA-827 is an authorization to disclose information to the Social Security Administration (SSA). Read the entire form, both pages, before signing.

Who signs: PLEASE SIGN USING BLUE OR BLACK INK ONLY: the Individual authorizing disclosure signs in the Signature box.

A filled-in Form SSA-827 example: a disability claimant signs for herself

Form SSA-827 example filled out, example: a disability claimant signs for herself — Maria Ann Sample signs Form SSA-827 for her own disability claim. She authorizes disclosure of her records, and one witness knows her. The picture shows page 1, and none of its entries is real. Her claim concerns eligibility for benefits, so the managing benefits ONLY box in Purpose stays empty. She signs for herself, so nothing goes in If not signed by the subject of disclosure. She signs with her name, so the second witness lines in Witness stay empty.

How to fill out Form SSA-827, box by box

Whose Records to be Disclosed

Under Whose Records to be Disclosed, enter NAME (First, Middle, Last, Suffix), SSN and Birthday (MM/DD/YYYY).

Purpose

The purpose is determining your eligibility for benefits, including looking at the combined effect of any impairments that by themselves would not meet SSA's definition of disability; and whether you can manage such benefits. Check the box for determining whether you are capable of managing benefits ONLY (check only if this applies). To whom: the Social Security Administration and the State agency authorized to process your case (usually called "disability determination services"), including contract copy services, and doctors or other professionals consulted during the process. For international claims, also the U.S. Department of State Foreign Service Post.

Signature of the individual authorizing disclosure

PLEASE SIGN USING BLUE OR BLACK INK ONLY: the Individual authorizing disclosure signs in the Signature box.

Expires when: this authorization is good for 12 months from the date signed (under your signature).

Enter the Date Signed, Street Address, Phone Number (with area code), City, State and ZIP.

If not signed by the subject of disclosure

If the form is not signed by the subject of disclosure, specify the basis for authority to sign: Parent of minor, Guardian, or Other personal representative (explain). The Parent/guardian/personal representative signs on the second line if two signatures are required by State law.

Witness

Under WITNESS, a witness who knows the person signing this form or is satisfied of this person's identity signs in the Signature box. A second witness signs if needed (e.g., if signed with "X"). Each witness enters a Phone Number (or Address).

More rules for Form SSA-827

Specific permission to release: 1. All records and other information regarding your treatment, hospitalization, and outpatient care for your impairment(s) including, and not limited to: psychological, psychiatric or other mental impairment(s) (excludes "psychotherapy notes" as defined in 45 CFR 164.501); drug abuse, alcoholism, or other substance abuse; sickle cell anemia; records which may indicate the presence of a communicable or noncommunicable disease, and tests for or records of HIV/AIDS; gene-related impairments (including genetic test results). 2. Information about how your impairment(s) affects your ability to complete tasks and activities of daily living, and affects your ability to work. 3. Copies of educational tests or evaluations, including Individualized Educational Programs, triennial assessments, psychological and speech evaluations, and any other records that can help evaluate function; also teachers' observations and evaluations. 4. Information created within 12 months after the date this authorization is signed, as well as past information.

The sources are all medical sources (hospitals, clinics, labs, physicians, psychologists, etc.) including mental health, correctional, addiction treatment, and VA health care facilities, all educational sources (schools, teachers, records administrators, counselors, etc.), social workers/rehabilitation counselors, consulting examiners used by SSA, employers, insurance companies, workers' compensation programs, and others who may know about your condition (family, neighbors, friends, public officials).

You have the right to revoke this authorization at any time, except to the extent a source of information has already relied on it to take an action. To revoke, send a written statement to any Social Security Office.

Furnishing the information is voluntary. However, failing to provide all or part of the information may prevent SSA from making an accurate and timely decision on your claim, and could result in a denial or loss of benefits.

It will take about 10 minutes to read the instructions, gather the facts, and answer the questions.

A covered entity (that is, a source of medical information about you) may not condition treatment, payment, enrollment, or eligibility for benefits on whether you sign this authorization form.

Common questions about Form SSA-827

What is form 827?

Form SSA-827 is an authorization to disclose information to the Social Security Administration (SSA). Read the entire form, both pages, before signing. SSA needs your written authorization to help get the information required to process your claim, and to determine your capability of managing benefits.

Where do I file it?

Send or bring the completed form to your local Social Security office. You may call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).

What am I certifying when I sign?

By signing you say: I have read both pages of this form and agree to the disclosures from the types of sources listed.

Sources

[1] Form SSA-827 (06-2024), Authorization to Disclose Information to the Social Security Administration (SSA) (the Official source link on this page).