Disability Determination Activities Form Info
This document provides guidance on the Activities of Daily Living Form required for disability determinations. It outlines steps for clients and advocates to ensure proper submission. The file is essential for applicants claiming disability-related benefits.
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To fill out this form, begin by carefully reading all instructions provided. Ensure you have all necessary information and documents ready. Follow the step-by-step guidelines to complete and submit the form accurately.

How to fill out the Disability Determination Activities Form Info?
1
Read the instructions carefully.
2
Gather necessary documents.
3
Complete the Activities of Daily Living Form.
4
Check for accuracy and completeness.
5
Submit the form to your caseworker.
Who needs the Disability Determination Activities Form Info?
1
Individuals applying for FAP who claim a disability.
2
SDA applicants who need to prove their disability.
3
Medicaid applicants with blindness or other disabilities.
4
Advocates assisting clients with their applications.
5
Healthcare professionals assisting patients with applications.
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What are the instructions for submitting this form?
To submit the completed Activities of Daily Living Form, you can send it via email to info@ccj-mi.org, or by fax to (989) 755-3558. Alternatively, you can mail it to the Center for Civil Justice at 320 S. Washington, 2nd Floor, Saginaw, MI 48607. Ensure that you keep a copy of your submission for your records and follow up with your caseworker as needed.
What are the important dates for this form in 2024 and 2025?
Important dates for submission vary based on specific program deadlines. Ensure to check with your caseworker for specific application timelines. Generally, timely submissions are recommended to avoid gaps in benefits.

What is the purpose of this form?
The purpose of the Activities of Daily Living Form is to assess the daily capabilities of individuals applying for disability benefits. It serves as a crucial tool for the Medical Review Team to evaluate eligibility for programs such as FAP, SDA, and MA. Completing this form accurately is essential for ensuring applicants receive the benefits they qualify for.

Tell me about this form and its components and fields line-by-line.

- 1. Personal Information: Includes the applicant's name, address, and contact details.
- 2. Daily Activities: Captures information on how the disability affects daily living activities.
- 3. Medical History: Requires details on medical diagnoses and treatments related to the disability.
- 4. Living Environment: Information about the applicant's living situation and support systems.
- 5. Submission Details: Guidelines for returning the completed form.
What happens if I fail to submit this form?
Failure to submit the Activities of Daily Living Form may result in delays in processing your disability benefits. Your caseworker is still required to forward your medical records for assessment, but missing forms could lead to complications in the determination process.
- Delays in Benefits: Missing submissions can lead to extended waits for necessary assistance.
- Application Denial Risk: Incomplete submissions may risk being denied disability benefits.
- Communication Issues: Not providing required documents can cause misunderstandings with caseworkers.
How do I know when to use this form?

- 1. Initial Application: When first applying for FAP, SDA, or MA.
- 2. Redetermination Process: When your benefits are being reviewed and updated.
- 3. Providing Medical Evidence: To accompany claims of disability or blindness.
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