1. If state law does not require the signature of a child for disclosure of medical
records, use the following language:
“We request the following documents to process your claim for benefits. The sooner
we receive the documents, the sooner we can process your application. If you would
like us to help get your medical reports, a parent or guardian should sign and date
Form SSA-827 (Authorization to Disclose Information to the Social Security Administration
(SSA)) in the appropriate spaces. Have someone else sign in the space marked “witness.”
Include your complete mailing address. Return Form SSA-827 in the enclosed envelope.”
NOTE: If an individual chooses to sign Form SSA-827 using the attestation process during
the teleclaim, employees should advise the individual not to sign and return the paper
form.
2. If state law requires both the signature of the child and their parent or guardian
for disclosure of medical records, use the following language:
“We request the following documents to process your claim for benefits. The sooner
we receive the documents, the sooner we can process your application. If you would
like us to help get your medical reports, please sign and date Form SSA-827 (Authorization
to Disclose Information to the Social Security Administration (SSA)). Have someone
else sign in the space marked “witness.” Include your complete mailing address. If
the claim is for a child, both the child and a parent or guardian should sign Form
SSA-827 in the appropriate spaces. Return Form SSA-827 in the enclosed envelope.”