Form SSA 4815-F6, Medical Report on Child with Allegation of HIV Infection (2004)

Client/Agency Forms

An essential form that is mysteriously unavailable on the Social Security Administration's website, this document is used by a child's health care provider to establish to the SSA field office processing the claim that manifestations of the applicant's HIV disease are sufficiently severe to warrant presumptive eligibility for benefits. According to SSA, this form was created to provide information to the SSA field office in order to permit the earliest possible payments to people living with HIV infection. The field office may make a finding of presumptive disability for any individual with HIV infection whose doctor provides information that confirms that the individual's disease manifestations are of listing-level severity, regardless of whether the individual has been diagnosed with AIDS. The relevant federal code provision is located at 20 C.F.R. § 416.933.

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