Authorization to Disclose Information to the Social Security Administration (Internet Instructions)

SSA-827

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Social Security Online

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Disability Programs
Authorization to Release Medical and Other
OMB Control No. 0960-0623
Information

Disability Home

How Do I Get the
Forms?

If you call us to apply, we will mail you the forms.
OR you may visit your nearest Social Security
Office
OR you can print the forms (see Printing
Authorization Forms). We need your dated
original signature on all forms.
IMPORTANT: When you contact us to apply, we
will tell you where to send or bring the forms.

No. The form and instructions on this site apply to
I'm Applying for A
Child. Are the Forms children and adults
Different?
More About Benefits for Children with Disabilities
If you need help with any Social Security forms,
you can call us toll free at 1-800-772-1213 or visit
your local Social Security office. We'll be glad to
help you.
More information about how to contact us.
Instructions: FORM
SSA-827

We need your written authorization to help get the
information required to process your claim. The
SSA-827 is arranged in several sections that
provide the most important items legally required
for an authorization.
Important Note:
This form is NOT an application for disability
benefits. You must contact SSA to apply. These
forms are used in addition to your application to
collect information about you so we can decide if
you meet Social Security's definition of disability.

What is this Form
Used For?

The Authorization to Release Information will be
used to request medical records from your health
care providers and other people who can provide
us with information about your disability. We will
need a separate form for each place or person that
will provide information.

This form is used to contact your doctors and
other health care providers, and others who

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will give us information about you to help us
decide your application for disability benefits.
When you apply, we will give you the forms.
But for convenience, they are available on
the Internet.

The "OF WHAT" section has everything needed
for the release of what is considered especially
sensitive information, about mental impairment(s);
substance abuse; sickle cell anemia; HIV/AIDS or
tests for HIV or sexually transmitted diseases; and
gene-related impairments (including genetic test
results). This specific authorization is routinely
included on the form to speed processing the claim
and does not mean that we think you may have
any of these conditions. Item number 3, about
educational tests, usually only applies when the
subject of the disclosure is a child. In order to
avoid delays caused by getting more forms signed
in the future, we also ask you to authorize
disclosure of information that may result from
treatment after you sign the form. If you have
questions regarding this section, or any other
aspect of the SSA-827 call 1-800-772-1213 or
contact your local Social Security office.
The "FROM WHOM" section covers all the
sources we may need to contact to help get
information about your claim. We need an original
signed, dated, and witnessed (not photocopied)
form for EACH medical or other source that you
listed on your disability report form(s):
(SSA-454, SSA-782, SSA-3368, SSA-3441, SSA3820, SSA-3881, HA-4486).
Please include at least 2 extra original, signed,
dated, and witnessed forms. These forms may be
used to get information from sources that you had
forgotten about. (For example, if you have 5
sources, we will need at least 7 SSA-827s). Please
do not send us copies of a signed form.
The other sections of the form are fairly selfexplanatory.
How to Complete the
Form?

1. Read the entire form, front and back. The
information on the back explains some more
about how the form will be used and explains
the possible consequences of not signing the
form. Additional instructions are also on the
form. If you have any questions, please

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2.

3.

4.
5.

6.
7.
8.

contact us.
Be sure the name of the person whose
records must be disclosed (the applicant or
beneficiary) is written in the upper right
corner of the form, with their own Social
Security Number.
Do not fill in the large empty box in the
middle of the form; SSA will use this space to
help the source identify the information we
need.
Do not put a check in the empty block under
"PURPOSE" unless SSA specifically asks
you to.
INDIVIDUAL SIGN" - Sign each form in this
block.
 An adult should sign his/her own form.
 An individual can sign with an "X" if
necessary.
 If an individual has been declared
legally incompetent, his/her legal
guardian or other legally recognized
representative should sign the form.
 If the individual whose information is
going to be disclosed is not the one
signing the form, be sure to check the
box to the right that shows that
person's authority to sign (parent,
guardian, etc.) and then give proof of
that legal relationship to SSA. If the
subject of disclosure is a minor, then a
custodial parent, guardian or other
legally recognized representative
should sign the form.
 If the subject of the disclosure is age 12
or older but still considered to be a
minor under State law, he or she
should sign the form and the parent,
guardian or other legally recognized
representative should sign in the
"Parent/guardian sign" area to the right.
ALWAYS enter the DATE the form is signed.
Enter the address and daytime phone
number of the individual signing the form.
"WITNESS SIGN" - The signature of the
individual signing the forms must be
witnessed by at least one other individual.
Many sources will not honor our request
unless it is witnessed.
 The witness can be any competent
adult (spouse, social worker, Social

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Printing
Authorization
Forms?

Security employee, etc.).
The witness should sign and provide
his or her address information in case
the source wants to confirm the
signature.
A second witness is usually only
required if the subject of the disclosure
signs with an "X."

SSA offers forms in Portable Document Format
(PDF). To read and print a PDF publication, you
must have the Adobe Acrobat Reader ® software
installed on your computer. You can download the
Adobe Acrobat Reader for no charge.
Authorization to Release Information Form (SSA827)

What to do with the
Form?

Mail it to the Social Security office that is servicing
your claim or bring it with you if you are going into
that office. If you have not yet filed a claim, please
contact us about filing an application for disability
benefits. CONTACT SOCIAL SECURITY NOW.
Other SSA Forms
Disability Report Form Guide
Learn More About Disability Benefits and How We
Decide If You Are Disabled

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Last reviewed or modified Wednesday Dec 12, 2007

http://www.ssa.gov/disability/3368/forms.htm

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12/27/2007

The following revised PRA Statement will be inserted into the instructions
at its next scheduled update:
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 3
minutes to read the instructions. You may send comments on our time estimate above to:
SSA, 6401 Security Blvd, Baltimore, MD 21235-6401. Send only comments relating to
our time estimate to this address, not the completed form.