Form Ssa 831 C3 U3 – Fill Out and Use This PDF

Form SSA 831 C3 U3 is a dynamic tool for assessing potential medical eligibility for disability services. It applies to recipients over the age of 18 and helps to efficiently collect relevant information related to physical or mental impairments, focusing primarily on how this disability affects someone's day-to-day functioning. In essence, it collects detailed assessments that allow Social Security Administration staff to make informed decisions when determining whether or not an individual is eligible for disability protection services. This form is necessary as it serves an important purpose in debriefing applicants and creating fair levels of support for those seeking assistance.

Form Ssa 831 C3 U3 PDF Details

When an individual is no longer able to work and earn an income, they may qualify for Social Security Disability Insurance (SSDI) benefits. In order to be approved for these benefits, the individual must have a qualifying condition that meets the Social Security Administration's definition of disability. One such condition is Intellectual Disability (ID). To better understand how ID qualifies for SSDI benefits, let's take a closer look at the definition of intellectual disability from the SSA. For more information on how to apply for SSDI benefits, please visit our website or contact us today. We would be happy to help you file your claim and provide more information on this important program.

Question	Answer
Form Name	Form Ssa 831 C3 U3
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	requestment, SSA-831, DPB, SSN

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Form Approved

SOCIAL SECURITY ADMINISTRATION

OMB No. 0960-0437

DISABILITY DETERMINATION AND TRANSMITTAL

1. DESTINATION

2. DDS CODE

3. FILING DATE

4. SSN

BIC (if CDB or DWB CLAIM)

DDS ODO DPB DQB

OIO

5. NAME AND ADDRESS OF CLAIMANT (include ZIP Code)

6. WE'S NAME (IF CDB OR DWB CLAIM)

7. TYPE CLAIM (Title II)

DIB FZ

DWB

CDB-R

CDB-D RD-R

RD-D RD

P-R

P-D MQFE

8. TYPE CLAIM (Title XVI)

9. DATE OF BIRTH

10. PRIOR ACTION

11. REMARKS

12. DISTRICT-BRANCH OFFICE ADDRESS (include ZIP Code)

DO-BO

CODE

13. DO-BO REPRESENTATIVE

14. DATE

11A. Presumptive

Disability

11B.

Impairment

DETERMINATION PURSUANT TO THE SOCIAL SECURITY ACT, AS AMENDED

15. CLAIMANT DISABLED

A. Disability

Began

B. Disability

Ceased

17. DIARY TYPE MO./YR. REASON

16A. PRIMARY DIAGNOSIS

BODY SYS.

CODE NO.

16B. SECONDARY DIAGNOSIS

CODE NO.

18. CASE OF BLINDNESS AS DEFINED IN SEC. 1614(a)(2)/(216)(i)

19. CLAIMANT NOT DISABLED

Not Disab. for Cash

Disab. for Cash Benefit Purp.

Through Date of

Before Age 22

Current Determination

B. Through

(CDB only)

Bene. Purp.

Beg.

20. VOCATIONAL BACKGROUND

OCC YRS.

ED YRS.

21. VR ACTION

SC IN

SC OUT Prev Ref

22. REG-BASIS CODE

23. MED LIST NO.

24. MOB CODE

25. REVISED

25A.

Initial

Recon

Recon DHU

ALJ Hearing

Appeals Council

U.S. District Court

DET

26.

LIST

NO.

27. RATIONALE

See Attached

Check if Vocational

SSA-4268-U4/C4

Rule Met. Cite Rule

28.

Continues

Period of Disability

Disability Period C.

Estab Beg

AND D.

Term

29. LTR/PAR NO.

30. DISABILITY EXAMINER-DDS

31. DATE

32. PHYSICIAN OR MEDICAL SPEC. SIGNATURE

33. DATE

32A. PHYSICIAN OR MEDICAL SPEC. NAME (Stamp, Print or Type)

32B. SPEC. CODE

34. REMARKS

MULTIPLE IMPAIRMENTS

CONSIDERED

34A.

COMBINED MULTIPLE

NONSEVERE-SEVERE

34B.

COMBINED MULTIPLE

NONSEVERE-

NONSEVERE

35. BASIS CODE

36. REV. DET.

37. SSA REPRESENTATIVE

SSA

38. DATE

CODES

CODE

Form SSA-831 C3/U3 (12-2001) ef (07-2006)

Electronic Input:

DECISION

CASE CONTROL

(3 copies - Folder, VR, State Agency)

PRIVACY ACT/PAPERWORK ACT NOTICE

We are authorized to collect this information under Sections 221 (a) and (b) of the Social Security Act and Sections 404.1615(d) and 416.1015 (d) of the Code of Federal Regulations. The information will be used to determine eligibility for benefits and for program evaluation and management. You are not required to complete this form, however, failure to do so could affect the claimants eligibility for benefits.

We may also use the information you give us when we match records by computer. Matching programs compare our records with those of other Federal, State, or local government agencies. Many agencies may use matching programs to find or prove that a person qualifies for benefits paid by the Federal government. The law allows us to do this even if you do not agree to it.

Explanations about these and other reasons why information you provide us may be used or given out are available in Social Security Offices. If you want to learn more about this, contact any Social Security Office.

PAPERWORK REDUCTION ACT STATEMENT - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control number. We estimate that it will take about 15 minutes to read the instructions, gather the facts, and answer the questions. You may send comments on our time estimate above to: SSA, 1338 Annex Building, Baltimore, MD

21235-6401. Send only comments relating to our time estimate to this address, not the completed form. All requests for Social Security cards and other claims related information should be sent to your local Social Security office.

Form SSA-831 C3/U3 (12-2001) ef (07-2006)

Form Ssa 831 C3 U3 – Fill Out and Use This PDF

Form Ssa 831 C3 U3 PDF Details

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