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.

Form NamePtax 343 A Form
Form Length2 pages
Fillable fields0
Avg. time to fill out30 sec
Other namesform ptax 343 a, ptax 343 a homestead exemption, ptax 343 application, ptax 343

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

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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


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.




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

Daytime phone

2Write the assessment year for which you

are requesting the DPHE:

___ ___ ___ ___



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 ___ ___/___ ___/___ ___ ___ ___


Can the patient do the same type of work as prior to their disability?



6a Was the patient able to work for a living after this date?



Has the disability lasted or is it expected to continue for 12 months or more?


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

No No



2.00Special Senses and Speech








10.00Impairments that Affect Multiple Body



13.00Malignant Neoplastic


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





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.


Musculoskeletal System


Skin Disorders


Special Senses and Speech


Endocrine System


Respiratory System


Impairments that Affect Multiple Body Systems


Cardiovascular System




Digestive System


Mental Disorders


Genitourinary System


Malignant Neoplastic Diseases


Hematological Disorders


Immune System




Offi cial use. Do not write in this space.



Date received: ___ ___/___ ___/___ ___ ___ ___

DFPR license verifi ed: ___ ___/___ ___/___ ___ ___ ___













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

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