Get Certification Of Eligibility For Disability Set Aside Unit

This guide provides a comprehensive overview of filling out the CERTIFICATION OF ELIGIBILITY FOR DISABILITY SET ASIDE UNIT. Users can expect clear and supportive instructions to ensure their application is completed accurately and submitted efficiently.

Follow the steps to complete your application online.

1. Click ‘Get Form’ button to access the form and open it in the editor.
2. Fill in the date in the designated space at the top of the form.
3. Enter the applicant's head of household name in the provided field.
4. Input the phone number in the specified format: (___) ___-____.
5. Add your current address, ensuring to include the street, city, and ZIP code.
6. Provide the name of the household member who has a mobility, vision, or hearing disability.
7. Indicate the relationship of the household member with a disability to the applicant.
8. Respond to the question about whether the household member uses a wheelchair or has a mobility disability by checking the appropriate box.
9. If applicable, confirm whether the mobility disability is expected to continue for at least 12 months by checking the corresponding box.
10. Answer the questions regarding hearing and vision disabilities by checking 'yes' or 'no' as applicable.
11. Review the certification statement and sign it, ensuring you understand the implications of providing false information.
12. Date your signature in the provided space.
13. Complete the next page with information from an appropriate licensed health care professional, as required.
14. After completing both pages, verify all information is accurate before submission.
15. Save any changes made to the form, and choose one of the following options: download, print, or share it as needed.

Complete your CERTIFICATION OF ELIGIBILITY FOR DISABILITY SET ASIDE UNIT online today!