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Get NY DOH-5139 2021-2024

YOUR EDUCATION, LITERACY AND ABILITY TO COMMUNICATE IN ENGLISH If a disability determination cannot be made based on your medical conditions alone, the factors of education, literacy, ability to communicate in English, and work history will be used to determine disability. A. If you are age 21 or under and are attending school or a vocational program, please provide the school or program s name and address. School/Program Name: Address: Please complete the DOH-5173, Authorization for Release.

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