Medical Source Statement of Ability to Do Work-Related Activities (Mental) - SSA-1152

Medical Source Statement of Ability to Do Work-Related Activities

OMB: 0960-0662

IC ID: 188400

Documents and Forms

Document Name Document Type
Form HA-1152 Medical Source Statement of Ability to Do Work-Related Activities (Mental) - SSA-1152 Form
HA-1152 Medical Source Statement of Ability to Do Work-Related Activity (Mental) HA-1152-U3 (revised).pdf Form
HA-1152-U3 (current).pdf HA-1152-U3 (current) IC Document