Disability Verification Form
Devra Edelman
- Require a copy of the signed record with the licensed evaluator information if the person signing the form has not personally evaluated or treated the patient.
- Adding a line for the license number to confirm that the form is signed by someone who is state licensed, with a note that if the Evaluator/Diagnostician is a Physician's Assistant or Nurse Practitioner, the form will need the signature of the supervising physician. (I am also attaching for your reference a document that reviews what professionals can sign off on the disability verification form)
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Emily Allen
Devra
Thank you -this is great!
We have one more disability related question. How does the staff observation work in other communities? We’ve recently had a provider want to provide this for a property that will require chronic homeless verification.
Documentation of the head of household’s disability, including:
- Written verification of the disability from professional licensed by the state to diagnose and treat the disability;
- Written verification from the Social Security Administration;
- The receipt of a disability check (e.g. SSDI check or Veteran Disability Compensation);
- Intake staff-recorded observation of disability that, no later than 45 days from the application for assistance, accompanied by evidence above; or
- Other documentation approved by HUD.
All the best,
Emily Allen
From: Devra Edelman <de...@homebaseccc.org>
Sent: Thursday, December 11, 2025 5:52 PM
To: Emily Allen <eal...@countyofsb.org>
Cc: Kelly Shaban <ke...@homebaseccc.org>; Santa Maria / Santa Barbara County Continuum of Care <s...@homebaseccc.org>
Subject: Disability Verification Form
Caution: This email originated from a source outside of the County of Santa Barbara. Do not click links or open attachments unless you verify the sender and know the content is safe.
Devra Edelman
Hello again Emily –
I gathered some information about how this works in Chicago and San Francisco and am attaching their forms here for your reference.
In Chicago, our experience is that they prefer to have a designated staff person who is a licensed clinical social worker, counselor or health professional, and who is usually not the same person as who is doing the intake, write a letter or complete a form confirming observation of a disability. In San Francisco, both the client and staff sign the verification of disability form. The San Francisco form doesn’t point out the 45-day period to obtain documentation, but the Chicago form has some good language around that and states that this option should be used sparingly.
Considering that the HUD Documentation Requirements State "If the recipient or subrecipient does not have the appropriate documentation within 45 days, the funds to serve that participant are no longer eligible costs for the CoC Program-funded grant. Disability may never be documented based on oral third-party reports or self-certification by the potential program participant." I would recommend the Chicago process, but wanted to provide the San Francisco information as well for comparison.
I hope this helps and please reach out again if there are further questions,
Devra
| |||
| Pronouns: She/Her/Hers | |||
| p: 415-788-7961 ext. 336 w: www.homebaseccc.org | |||
| a: 870 Market Street, Suite 1228, San Francisco, CA 94102 | |||
| Advancing Solutions to Homelessness | |||
| Stay in touch with Homebase through our newsletter! | |||
| The content in this message is provided for information purposes only and does not constitute legal advice. Homebase does not enter into attorney-client relationships. |