TN 1 (08-11)

DI 29501.015 Administrative Law Judge Requests Completion of Medical Source Statement Forms

After reviewing the medical evidence, an administrative law judge (ALJ) may request that the treating or nontreating source complete a medical source statement on form:

  • HA-1151 (Medical Source Statement of Ability to Do Work Related Activities (Physical)) or

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

ALJ requests for medical source statements are made through the disability determination services (DDS) and may be in conjunction with any other request to the treating source or for a consultative examination (CE). If an ALJ requests the medical source statement separately, follow the development procedures for ALJ-requested medical evidence from a treating source.

See Details:

  • DI 29501.005 Administrative Law Judge Requests to Disability Determination Services for Medical Evidence from a Treating Source

  • DI 29501.010 Administrative Law Judge Requests Assistance to Obtain a Consultative Examination


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0429501015
DI 29501.015 - Administrative Law Judge Requests Completion of Medical Source Statement Forms - 08/11/2011
Batch run: 08/11/2011
Rev:08/11/2011