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Get Confirmation of Legal Blindness form

CONFIRMATION OF LEGAL BLINDNESS URL to download form www. nfb. org/scholarships. Confirmation of legal blindness is required for special consideration or disability services from the IRS Social Security and other federal state and private organizations. The federal government defines blindness as follows T he term blindness means central visual acuity of 20/200 or less in the better eye with the use of a correcting lens. An eye which is accompanied by a limitation in the fields of vision such that the widest diameter of the visual field subtends an angle no greater than 20 degrees shall be considered for purposes in this paragraph as having a central visual acuity of 20/200 or less. Social Security Act 42 U*S*C. 416 i 1 B Supp* IV 1986. 1 Translation A person is considered legally blind if the vision in the right eye and the left eye both eyes is 20/200 or less when wearing glasses or contacts or both or if the field of vision for both eyes together is 20 degrees or less. Consumer/Client/Patient Name Date of Birth Address Best corrected vision OD Right Eye. OS Left Eye. OU Both Eyes. Visual field in degrees. Specific eye condition s Certifying Authority I certify that is legally blind in both eyes as specified in the federal definition quoted above. Signed Date Title Please attach your business card or print/type your name profession and address here. The federal government defines blindness as follows T he term blindness means central visual acuity of 20/200 or less in the better eye with the use of a correcting lens. An eye which is accompanied by a limitation in the fields of vision such that the widest diameter of the visual field subtends an angle no greater than 20 degrees shall be considered for purposes in this paragraph as having a central visual acuity of 20/200 or less. An eye which is accompanied by a limitation in the fields of vision such that the widest diameter of the visual field subtends an angle no greater than 20 degrees shall be considered for purposes in this paragraph as having a central visual acuity of 20/200 or less. Social Security Act 42 U*S*C. 416 i 1 B Supp* IV 1986. 1 Translation A person is considered legally blind if the vision in the right eye and the left eye both eyes is 20/200 or less when wearing glasses or contacts or both or if the field of vision for both eyes together is 20 degrees or less. Social Security Act 42 U*S*C. 416 i 1 B Supp* IV 1986. 1 Translation A person is considered legally blind if the vision in the right eye and the left eye both eyes is 20/200 or less when wearing glasses or contacts or both or if the field of vision for both eyes together is 20 degrees or less. Consumer/Client/Patient Name Date of Birth Address Best corrected vision OD Right Eye. OS Left Eye. Consumer/Client/Patient Name Date of Birth Address Best corrected vision OD Right Eye. OS Left Eye. OU Both Eyes. Visual field in degrees. Specific eye condition s Certifying Authority I certify that is legally blind in both eyes as specified in the federal definition quoted above. .

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