Legal Blindness Form PDF Details

When you are considering a legal case, it is important to have all of the relevant information in order to make an informed decision. The Legal Blindness Form can help you do just that. This form is designed to provide you with a clear overview of your case, and allow you to make an educated decision about whether or not to pursue legal action. With the help of this form, you can be sure that you are making the best possible decision for yourself and your loved ones.

You may find information about the type of form you intend to complete in the table. It can show you the time you will need to complete legal blindness form, what fields you will have to fill in and some other specific facts.

QuestionAnswer
Form NameLegal Blindness Form
Form Length1 pages
Fillable?Yes
Fillable fields12
Avg. time to fill out2 min 39 sec
Other namesblind forms legally, forms blind legally, confirmation blindness sample, legally blind forms

Form Preview Example

CONFIRMATION OF LEGAL BLINDNESS

The federal definition [10] of "blindness" in the Supplemental Security Income program under Title XVI of the Social Security Act currently states:

(2)"An individual shall be considered to be blind for purposes of this title if he has central visual acuity of 20/200 or less in the better eye with the use of a correcting lens. An eye which is accompanied by a limitation in the fields of vision such that the widest diameter of the visual field subtends an angle no greater than 20 degrees shall be considered for purposes of the first sentence of this subsection as having a central visual acuity of 20/200 or less. http://www.ssa.gov/OP_Home/ssact/title16b/1614.htm

Translation: If you wear your glasses or contacts (or both) and then are measured on an eye chart as seeing 20/200 or less, or if the width of vision for both your eyes totals an arc of 20 degrees or less, you are legally blind according to this federal definition.

CONSUMER / CLIENT / PATIENT:

Name: __________________________________________ Date of Birth: ________

Address: _____________________________________________________________

Best corrected vision:

OD (right eye) _________ OS (left eye) _________ OU (both eyes _________

Width of Visual Field (in degrees): ____________

Specific eye condition(s):_______________________________________________

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CERTIFYING AUTHORITY:

I certify that ___________________________ is legally blind in both eyes

as specified in the federal definition quoted above.

(Signed) ______________________________________ (Date) _________.

(Title) _____________________________________________

Please attach your business card OR print/type your name, profession, and address here:

How to Edit Legal Blindness Form Online for Free

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Step 1: Press the orange button "Get Form Here" on the website page.

Step 2: You'll find all the actions which you can take on the document once you've got entered the legally blind tax form editing page.

You should provide the following details to complete the legally blind tax form PDF:

part 1 to writing confirmation of legal blindness form

Complete the Title section with the information demanded by the program.

confirmation of legal blindness form Title fields to insert

Step 3: When you hit the Done button, your finalized document can be transferred to any of your devices or to email chosen by you.

Step 4: It will be better to have duplicates of the file. You can rest assured that we are not going to publish or view your data.

Watch Legal Blindness Form Video Instruction

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