Medical Source Statement of Ability to Do Work-Related Activities

ICR 202404-0960-013

OMB: 0960-0662

Federal Form Document

Forms and Documents

Document Name	Status
Form HA-1151-BK Medical Source Statement of Ability To Do Work-Related Activities (Physical) - SSA-1151 Form	Modified
Form HA-1152 Medical Source Statement of Ability to Do Work-Related Activities (Mental) - SSA-1152 Form	Modified
Supporting Statement - 0662 (Final).docx Supporting Statement A	2024-07-05
Addendum - 0662 (Final).docx Supplementary Document	2024-07-05

IC Document Collections

IC ID	Document Title	Status
9709	Medical Source Statement of Ability To Do Work-Related Activities (Physical) - SSA-1151 Form	Modified
188400	Medical Source Statement of Ability to Do Work-Related Activities (Mental) - SSA-1152 Form	Modified