TN 25 (08-13)

Citations:

P.L. 104–191 Health Insurance Portability and Accountability Act; 45 CFR parts 160 and 164; 42 CFR part 2; 38 CFR 1.475; 34 CFR parts 99 and 300 and State law; 42 U.S.C. section 290dd-2; 38 U.S.C. section 7332; 20 U.S.C. section 1232g Family Education Rights and Privacy Act (FERPA)

A. When to obtain Form SSA-827

Generally, the field office (FO) obtains one signed Form SSA-827 from the claimant at each adjudicative level (initial, reconsideration, and hearing) to process disability claims or continuing disability reviews.

If the adjudicating component (for example, the disability determination services (DDS)) needs an additional original, signed and dated Form SSA-827 in addition to the one obtained by the FO, the adjudicating component obtains the form.

For information on responsibilities when the claimant fails to provide a signed Form SSA-827, see DI 23007.005.

B. When attestation is permitted

The SSA or DDS employee may use the attestation process in DI 22501.007E, in this section, to obtain a signed and dated Form SSA-827 under the following conditions:

1. The claimant is one of the following:

   • an adult (age 18 or older) who is signing on his or her own behalf, or

   • a child (under age 18) who is signing on his or her own behalf, or

   • a child whose claim is being pursued by an individual with the authority to sign on behalf of a child claimant (for example, a parent or guardian).

2. The case is available in eView.

3. The individual signing the Form SSA-827 chooses to sign using the attestation process in one of the following situations:

   • During a FO disability interview (for example, in office, video conference, or teleclaim interviews); or

   • Via face-to-face or telephone contact with an SSA or DDS employee (for example, Form SSA-827 expired prior to adjudication).

C. When attestation is not permitted

We do not permit attestation when:

1. The claimant has not reviewed Form SSA-827.

   Claimants must have the opportunity to review Form SSA-827 before we permit attestation.

2. Two signatures are required.

   When the claimant and the parent, guardian, or other authorized personal representative need to sign Form SSA-827, use a paper form with a pen and ink signature.

3. The individual chooses not to attest.

   At any time before completing the attestation process, the individual can opt out of the attestation process, and continue with the paper (pen and ink signature) process.

   If the claimant chooses not to submit Form SSA-827, see DI 11018.005 for FO responsibilities when a claimant fails to cooperate.

4. The claim is an Electronic Disability Collect System (EDCS) exclusion without an associated electronic folder (EF).

D. How attestation works

1. The SSA or designated State agency employee (the employee) confirms the individual’s (claimant or form signer) intent to sign Form SSA-827 and to authorize disclosure of information to SSA. If the individual agrees, the employee attests to the individual’s intent to authorize disclosure by clicking the “Attest, Submit, and Print” button in the EDCS or eView. The employee's act of attesting to these facts documents the individual’s agreement. The process of the individual agreeing and the employee attesting constitutes a signature.

2. SSA systems then propagate the individual’s name (that is, “Electronically Signed By (first, middle, last name, and suffix)”), the date, and the individual’s identity information (based on information already collected) on an electronic version of Form SSA-827. In addition, SSA systems propagate the employee’s information (that is, “Attested by SSA or Designated State Agency Employee (first initial, last name)”) and office phone number, city, state, and ZIP code in the witness block on the electronic version of the form.

3. The employee provides a printed, paper copy of the signed Form SSA-827 to the individual for his or her records.

E. Obtaining a signed Form SSA-827 using eView and attestation procedures

In any situation where we permit attestation, follow these steps:

1. Contact the individual by telephone or in person. For represented claimants, follow instructions in GN 03910.050 and DI 31001.010.

2. Verify the claimant’s identity by confirming information on the Numident. For more information on identifying claimants, see GN 00203.020A.2.

   IMPORTANT: If you cannot confirm the individual’s identity, or have any doubt as to the individual’s identity, do not continue with the attestation process. Instead, obtain a pen and ink signed, paper Form SSA-827 from the individual.

3. Access the SSA-827 eAuthorization screen in eView.

4. Provide the individual with the opportunity to review Form SSA-827.

   NOTE: For telephone contacts, provide a copy of Form SSA-827 in advance (such as by mail) or direct the individual to a copy of the form online. http://www.ssa.gov/online/ssa-827.pdf

   IMPORTANT: Do not continue with the attestation process if the individual has not had the opportunity to review Form SSA-827. Mail the paper Form SSA-827, or direct the individual to a copy of the form online. http://www.ssa.gov/online/ssa-827.pdf

   Proceed with the attestation process once the individual has reviewed the form, or obtain a paper Form SSA-827 with a pen and ink signature.

5. For child claims that do not require two signatures, select or enter the name of the individual authorized to sign Form SSA-827 (when an individual’s name is entered, the address and telephone number must be entered). If someone other than the child is signing, select the basis for that individual’s authority to sign the form (that is, parent of minor, guardian, or other personal representative). If a personal representative signed the form, explain the individual’s “authority to sign” in the space provided. For more information about personal representatives, see DI 11005.056C.

   IMPORTANT: We do not permit attestation when we need two signatures. When both the claimant and the parent, guardian, or other personal representative need to sign Form SSA-827, use a paper form with a pen and ink signatures.

6. Read the scripted language found on the SSA-827 eAuthorization screen in eView.

7. Indicate the individual’s intent to authorize disclosure by selecting “Yes” or “No.”

8. If “Yes,” attest to the individual’s intent to authorize disclosure by clicking the “Attest, Submit, and Print” button.

   NOTE: The system automatically adds the signed Form SSA-827 to the EF. You do not need to fax the form into the EF.

9. If “No,” select the reason for declining and provide the individual with the opportunity to complete a paper Form SSA-827 with a pen and ink signature.

10. Mail the printed copy of the signed Form SSA-827 to the individual for his or her records.

F. References

• DI 11005.055 Completing Form SSA-827 (Authorization to Disclose Information to the Social Security Administration (SSA))

• DI 11005.056 Signature Requirements for Form SSA-827