Medical Source Statement of Ability to Do Work-Related Activities

When a claimant appeals a denied disability claim, SSA may ask the claimant to have a consultative examination at the agency’s expense, if the claimant’s medical sources cannot, or will not, give the agency sufficient evidence to determine whether the claimant is disabled. The medical providers who perform these consultative examinations provide a statement about the claimant’s state of disability. Specifically, these medical source statements determine the work-related capabilities of these claimants. SSA collects the medical data on the HA-1151 and HA-1152 to assess the work-related physical and mental capabilities of claimants who appeal SSA’s previous determination on their issue of disability. The respondents are medical sources who provide reports based either on existing medical evidence or on consultative examinations. We are submitting this Change Request to include two CFR citations from the rule-related ICR for 0960-0804 under this OMB approval. We will also submit the Discontinuation for 0960-0804 at the same time as we submit this Change Request. The addtion of these CFR ciations will increase the burden for this information collection.

The latest form for Medical Source Statement of Ability to Do Work-Related Activities expires 2027-11-30 and can be found here.

Medical Source Statement of Ability To Do Work-Related Activities (Physical) - SSA-1151

Federal Enterprise Architecture: Income Security - General Retirement and Disability

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