Include the responsible medical or psychological consultant’s specialty code on each
of the following:
1. Medical assessment forms
The following are disability program medical assessment forms:
-
•
SSA-2506-BK (Psychiatric Review Technique)
-
•
SSA-4734-BK (Physical Residual Functional Capacity Assessment)
-
•
SSA-4734-F4-SUP (Mental Residual Functional Capacity Assessment)
-
•
SSA-538-F6 (Childhood Disability Evaluation Form) for Title XVI childhood disability
cases
-
•
SSA-416 (Medical Evaluation)
2. Disability determination forms
The following are agency disability determination forms:
-
•
SSA-831 C3/U3 (Disability Determination and Transmittal)
-
•
SSA-832 C3/U3 (Cessation or Continuance of Disability or Blindness Determination and
Transmittal Title XVI), or
-
•
SSA-833 C3/U3 (Cessation or Continuance of Disability or Blindness Determination and
Transmittal Title II).