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.

Form NameLegal Blindness Form
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other namesblind legally forms, legally blind forms, forms blind legally, confirmation of legal blindness form

Form Preview Example


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.

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.


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):_______________________________________________

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -


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

We used the top-rated computer programmers to develop the PDF editor. The app will allow you to prepare the forms legally blind form with no trouble and won't consume too much of your time and effort. This straightforward guide will enable you to learn how to start.

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 forms legally blind editing page.

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

part 1 to writing confirmation of blindnss

Complete the Best corrected vision OD right eye, Width of Visual Field in degrees, I certify that is legally blind, Signed Date, Title, and Please attach your business card section with the information demanded by the program.

confirmation of blindnss Best corrected vision OD right eye, Width of Visual Field in degrees, I certify that  is legally blind, Signed  Date, Title, and Please attach your business card 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

Please rate Legal Blindness Form

1 Votes
If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .