The Family Support Division uses the below documents in order to make a disability determination for clients who do not actively receive Social Security Disability or SSI.
- IM-61B: Disability Questionnaire
- Fill in the client’s answers to all questions, describing the disability in detail to provide as complete a picture as possible. Leave the "Pertinent Information and Observations of FSD Staff" section blank.
- IM-61C: Work History - Past 10 years
- The form asks for the past 10 years work history. Complete the form based on information readily available from the individual, do not delay submitting the form trying to get exact information. If the individual doesn’t remember specific information such as phone numbers, addresses, monthly income, etc. just put an approximation based on what is remembered.
- IM-61D: Hospitals, Medicial Facilities, and Physicians Seen Within the Past Year
- The form asks the individual to list all hospitals, medical facilities, and physicians from whom he or she has received medical care in the past 12 months. Mental health professionals, such as psychologists and licensed clinical social workers should also be included. The Medical Review Team uses this information to gather additional records which will help them to establish disability.
- MO 650-2616: Authorization for Disclosure of Consumer Medical/Health Information
- This form allows Family Support Division to get medical records from the client's doctors and other providers.