Authorization to Disclose Information to the Social Security Administration (SSA)
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JustFill is not affiliated with Social Security Administration (SSA). This is an independent third-party tool to help you complete Form SSA-827. Always download the current blank form from the official source and verify your completed copy before signing or submitting. Official Form SSA-827 from Social Security Administration (SSA)
Form SSA-827, Authorization to Disclose Information to the Social Security Administration (SSA), is a release that lets your doctors, hospitals, schools, and employers send SSA the records it needs to decide a disability claim. It is completed and signed by the claimant (or their representative). JustFill lets you fill it online for free, then download the completed PDF for signing.
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Form SSA-827 is the Authorization to Disclose Information to the Social Security Administration (SSA), the consent form that allows SSA and the state Disability Determination Services to collect the records they need to evaluate a disability claim. By signing it, you authorize all of your medical sources (hospitals, clinics, doctors, mental health and substance-abuse providers, VA facilities), along with schools, social workers, employers, and others who know about your condition, to release records to SSA. The form names whose records are involved (name, SSN, date of birth), describes what may be disclosed, lists from whom and to whom, states the purpose, and notes that the authorization is good for 12 months from the date you sign. It ends with the individual's signature, address, and phone, plus a witness signature. The current edition is Form SSA-827 (06-2024) UF, OMB 0960-0623. With JustFill, the AI detects each field on the PDF, so you can type or dictate your details, handle scanned copies, and finish without Adobe Acrobat.
The official Form SSA-827 PDF is free to download from the Social Security Administration at ssa.gov/forms. JustFill opens that same PDF in your browser so you can fill it and download a completed copy with no Adobe Acrobat required.
What each section of Form SSA-827 asks for. JustFill’s AI will detect these fields automatically when you upload the PDF — review the breakdown below so you know what to enter.
Full name (first, middle, last) of the person whose records are being disclosed.
The claimant's Social Security number and birth date used to identify the right records.
Pre-printed scope covering medical records, mental health, substance abuse, and education records related to your ability to perform tasks.
The sources authorized to release records: medical, educational, employers, counselors, and others who know your condition.
States that information goes to SSA and the state agency processing your case, to determine eligibility for benefits.
Notes the authorization is valid for 12 months from the date signed.
The claimant's signature, date signed, street address, city, state, ZIP, and phone number.
Signature and phone or address of someone who knows the claimant or is satisfied as to their identity.
A fictional adult SSDI claimant in Columbus completes and signs Form SSA-827 in front of a witness so Social Security and the Ohio Division of Disability Determination can request medical records from his treating hospital and physicians. All names and numbers are fictional.
Name (First, Middle, Last, Suffix): Robert Alan Sample · SSN: •••-••-6471 · Birthday (mm/dd/yyyy): 07/19/1972
This header box must match the claimant's Social Security record so hospitals and clinics can locate the patient's chart.
Signed in ink by Robert Alan Sample · Date Signed: 10/22/2026 · Authority box left unchecked (claimant signing on his own behalf)
The authorization expires 12 months from the date signed, so leaving the date blank invalidates the release.
Street Address: 615 Sample High St, Apt 2A, Columbus, OH 43215 · Phone Number (with area code): (614) 555-0194
Provides the claimant's current contact details below the signature line.
I know the person signing this form or am satisfied of this person's identity: Signed by Witness Linda M. Sample · Phone/Address: (614) 555-0198, Columbus, OH
Form SSA-827 includes a witness attestation block confirming the identity of the person signing the release.
These values are made up. They are here to show what belongs on each line, not to be copied — every name, number, and address on your own Form SSA-827 has to be your own.
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Official source: Form SSA-827 on Social Security Administration (SSA)’s website
Edition checked: Form SSA-827 (06-2024) UF, OMB No. 0960-0623. Verified against the official source on · Verified in our Government Forms Fillability Study.
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