Form SSA 4814-F5, Medical Report on Adult with Allegation of HIV Infection

Categories

• Public Benefits Access

Resource Type

Client/Agency Forms  

Description

This essential form, mysteriously unavailable on the Social Security Administration's website, is used by a disability applicants health care provider to establish to the SSA field office processing the claim that manifestations of the applicants HIV disease are sufficiently severe to warrant presumptive eligibility for benefits. According to SSA, this form was created to provide information to the SSA Field Office in order to permit the earliest possible payments to people living with HIV infection. The Field Office may make a finding of presumptive disability for any individual with an HIV infection whose doctor provides information that confirms that the individual's disease manifestations are of listing-level severity, regardless of whether the individual has been diagnosed with AIDS. For the relevant federal code provision, go to 20 CFR 416.933.  

File

Click here to download this document [ 3.61 MB ]  

Published

2004-December-01