Ptax 343 A Form – Fill Out and Use This PDF

The PTAX-343-A form, known as the Physician’s Statement for Disabled Persons’ Homestead Exemption, serves as a crucial document for individuals seeking the Disabled Persons’ Homestead Exemption (DPHE) in Illinois. To qualify for this exemption, proof of disability is necessary, and this form, completed by both the applicant and an Illinois licensed physician, provides the required validation if other forms of proof are unobtainable. Filling out this form accurately is essential for those who wish to benefit from the DPHE.

Click the button below to start filling out your form and move closer to receiving your exemption.

Get Form Now Download PDF

Ptax 343 A Form PDF Details

Navigating the complexities of property tax exemptions for disabled persons can be a challenging process, requiring specific documentation and proof of disability. The PTAX-343-A form, also known as the Physician’s Statement for Disabled Persons’ Homestead Exemption, plays a critical role in this procedure. This document is designed for individuals who are unable to provide the standard proofs of disability listed on the form, necessitating a detailed certification from a licensed Illinois physician. Applicants are tasked with furnishing essential information about their property and the nature of their disability. Physicians, on their part, must verify the disability based on Social Security Administration criteria, ensuring the condition meets the stipulated severity and duration requirements. The form delineates a variety of impairments across major body systems, emphasizing the significance of a medical professional's validation in attaining the Disabled Persons’ Homestead Exemption (DPHE). Additionally, it outlines the responsibility of applicants for any related physicians' costs, and the requisite steps for submission to the Chief County Assessment Officer (CCAO), thereby underlining the procedural and financial aspects integral to securing property tax relief under this exemption.

Question	Answer
Form Name	Ptax 343 A Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	form ptax 343 a, ptax 343 a homestead exemption, ptax 343 application, ptax 343

Form Preview Example

PTAX-343-A Physician’s Statement for Disabled Persons’ Homestead Exemption

Read this ﬁrst

To qualify for the Disabled Persons’ Homestead Exemption (DPHE), proof of a disability is required. The acceptable proof of disabil- ity is listed on the back of this Form. If you are unable to provide any of these as proof of your disability, you and an Illinois licensed physician must complete Form PTAX-343-A. You are responsible for any physicians’ costs.

Step 1: Applicant - Complete the following information

1________________________________________________

Property owner’s name

________________________________________________

Street address of homestead property

3Write the property index number (PIN) of the property for which you are ﬁ ling this form. Your PIN can be found on your property tax bill or you may obtain it from your Chief County Assessment Ofﬁcer (CCAO). If you are unable to obtain your PIN, write the legal description on Line b.

__________________________________IL_____________

City

ZIP

(___ ___ ___)___ ___ ___ - ___ ___ ___ ___

Daytime phone

2Write the assessment year for which you

are requesting the DPHE:	___ ___ ___ ___
	Year

aPIN __ __ - __ __ - __ __ __ - __ __ __ - __ __ __ __

bAttach a separate sheet if needed.

_____________________________________________

Step 2: Physician - Complete the following information

Part A: Patient information - Please print.

The patient must meet the disability criteria established by the Social Security Administration.

Note: Alcoholism or drug abuse is not included in the Social Security Administration’s guidelines as a qualiﬁcation for disability status.

4Patient’s name: ____________________________________

5Date patient became disabled ___ ___/___ ___/___ ___ ___ ___

6	Can the patient do the same type of work as prior to their disability?	Yes
	6a Was the patient able to work for a living after this date?	Yes
7	Has the disability lasted or is it expected to continue for 12 months or more?	Yes

8Check all major body systems, disorders, and diseases of the patient’s disability:

No No

1.00Musculoskeletal

2.00Special Senses and Speech

3.00Respiratory

4.00Cardiovascular

5.00Digestive

6.00Genitourinary

7.00Hematological

8.00Skin

9.00Endocrine

10.00Impairments that Affect Multiple Body

11.00Neurological

12.00Mental

13.00Malignant Neoplastic

14.00Immune

9What is the nature of the disability? __________________________________________________________________________

Part B: Physician information

10Name: __________________________________________

11Your Illinois physician’s license number issued by the

Illinois Department of Financial and Professional Regulations: 0 3 6 - ___ ___ ___ ___ ___ ___

12Sign below:

I have examined this patient and based on the Social Security Administration’s criteria for disability, I state that the information contained in Step 2 is true, correct and complete to the best of my knowledge.

Physician’s signature: ___________________________________________________ Date: _____/_____/_____

PTAX-343-A (N-03//08) IL-492-4547

General Information

To qualify for the Disabled Persons’ Homestead Exemption (DPHE), proof of a disability is required. The acceptable proof of disability is listed below. If you are unable to provide any of these as proof of your disability, you and an Illinois licensed physician must complete Form PTAX-343-A.

You are responsible for any physicians’ costs.

What is considered proof of disability?

1A Class 2 Illinois Disabled Person Identiﬁcation Card from the Illinois Secretary of State’s Ofﬁce. Class 2 or Class 2A qualiﬁes, Class 1 or 1A does not qualify.

2Proof of Social Security Administration (SSA) disability beneﬁts which includes an award letter, veriﬁcation letter or annual Cost of Living Adjustment (COLA) letter

(only Form SSA-4926-SM-DI). If you are under the age of 65 receiving Supplemental Security Income (SSI) disability beneﬁts, proof includes a letter indicating SSI payments (SSA-L8151, SSA-L8155, or SSA-L8156).

3Proof of Veterans Administration disability beneﬁts which includes an award letter or veriﬁcation letter indicating you are receiving a pension for a non-service connected disability.

4Proof of Railroad or Civil Service disability beneﬁts which includes an award letter or veriﬁcation letter of total (100%) disability.

When and where must I ﬁle this Form PTAX-343-A?

You must ﬁ le Form PTAX-343- A with your Chief County Assessment Ofﬁcer (CCAO) at the address shown below prior to your county’s due date for the Disabled Persons’ Homestead Exemption (DPHE). Contact your CCAO at the telephone number or address below for assistance.

File or mail your completed Form PTAX-343-A:

_______________________________________ County, CCAO

____________________________________________________

Mailing address

	IL
City	ZIP

If you have any questions, please call: (____)_____-________

Social Security Administration’s Listing of Impairments

The Listing of Impairments describes, for each major body system, impairments that are considered severe enough to prevent a person from doing any gainful activity. Most of the listed impairments are permanent or expected to result in death, or a speciﬁc state- ment of duration is made. For all others, the evidence must show that the impairment has lasted or is expected to last for a continuous period of at least 12 months. The criteria in the listing of impairments are applicable to evaluation of claims for disability beneﬁts from the Social Security Administration (SSA). Visit SSA web site for more speciﬁc information.

1.00	Musculoskeletal System	8.00	Skin Disorders
2.00	Special Senses and Speech	9.00	Endocrine System
3.00	Respiratory System	10.00	Impairments that Affect Multiple Body Systems
4.00	Cardiovascular System	11.00	Neurological
5.00	Digestive System	12.00	Mental Disorders
6.00	Genitourinary System	13.00	Malignant Neoplastic Diseases
7.00	Hematological Disorders	14.00	Immune System

			Ofﬁ cial use. Do not write in this space.
Date received: ___ ___/___ ___/___ ___ ___ ___			DFPR license veriﬁ ed: ___ ___/___ ___/___ ___ ___ ___
Month	Day	Year	Month	Day	Year
			Month	Day	Year

Comments:______________________________________________

_______________________________________________________

PTAX-343-A (N-03//08)

How to Edit Ptax 343 A Form Online for Free

il ptax 343 a can be filled in effortlessly. Simply make use of FormsPal PDF editing tool to perform the job fast. FormsPal is aimed at giving you the best possible experience with our editor by continuously adding new functions and upgrades. With these updates, working with our tool gets easier than ever before! This is what you'll need to do to get started:

Step 1: Open the PDF in our editor by pressing the "Get Form Button" at the top of this page.

Step 2: After you launch the editor, you will notice the document all set to be filled in. Aside from filling out different blanks, you may as well do various other things with the form, such as writing any textual content, editing the original textual content, adding illustrations or photos, affixing your signature to the form, and more.

This form will require particular information to be entered, thus make sure you take the time to enter exactly what is required:

1. You will want to fill out the il ptax 343 a correctly, so take care when working with the segments comprising all of these blank fields:

2. Given that this section is finished, it's time to add the essential specifics in Musculoskeletal, Special Senses and Speech, Skin, Endocrine, Respiratory, Cardiovascular, Digestive, Genitourinary, Hematological, Impairments that Affect Multiple, Neurological, Mental, Malignant Neoplastic, Immune, and What is the nature of the allowing you to move on further.

Tips to complete form ptax 343 a portion 2

3. Completing To qualify for the Disabled, When and where must I ﬁ le this, What is considered proof of, County CCAO, Mailing address, City If you have any questions, ZIP, A Class Illinois Disabled Person, Illinois Secretary of States Ofﬁ, Proof of Social Security, SSAL SSAL or SSAL, Proof of Veterans Administration, includes an award letter or veriﬁ, Proof of Railroad or Civil, and includes an award letter or veriﬁ is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

When and where must I ﬁ le this, What is considered proof of, and Proof of Veterans Administration inside form ptax 343 a

4. Filling out Date received, Month Day Year, DFPR license veriﬁ ed, Month Day Year, Ofﬁ cial use Do not write in this, Comments, and PTAXA N is vital in the fourth step - don't forget to invest some time and fill in each empty field!

It's easy to make errors when completing the Date received, hence be sure you take a second look prior to when you send it in.

Step 3: After rereading your fields, click "Done" and you're done and dusted! Join us now and immediately obtain il ptax 343 a, ready for download. Every single modification you make is handily saved , which means you can change the file later as required. FormsPal guarantees your information confidentiality by using a secure method that never saves or distributes any sort of sensitive information used. Be assured knowing your paperwork are kept protected any time you work with our services!

Ptax 343 A Form – Fill Out and Use This PDF

Ptax 343 A Form PDF Details

Form Preview Example

How to Edit Ptax 343 A Form Online for Free

Ptax 343 A Form isn’t the one you’re looking for?

Related Documents