Form Ptax-343-A - Physician'S Statement For The Homestead Exemption For Persons With Disabilities - 2013 Page 2
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1
2General Information
To qualify for the Homestead Exemption for Persons with Dis-
When and where must I file this Form PTAX-343-A?
abilities (HEPD), proof of a disability is required. The acceptable
You must file Form PTAX-343- A with your Chief County
proof of disability is listed below. If you are unable to provide any
Assessment Officer (CCAO) at the address shown below prior to
of these as proof of your disability, you and an Illinois licensed
your county’s due date for the Homestead Exemption for Persons
with Disabilities (HEPD). Contact your CCAO at the telephone
physician must complete Form PTAX-343-A.
number or address below for assistance.
You are responsible for any physicians’ costs.
File or mail your completed Form PTAX-343-A:
What is considered proof of disability?
Jennifer Gomric Minton, St Clair
_______________________________________ County, CCAO
Disabled Persons’ Department, 10 Public Square
____________________________________________________
1
A Class 2 Illinois Person with a Disability Identification Card
Mailing address
from the Illinois Secretary of State’s Office. Class 2 or Class
2A qualifies, Class 1 or 1A does not qualify.
IL
Belleville
62220
____________________________________________________
City
ZIP
2 Proof of Social Security Administration (SSA) disability
benefits which includes an award letter, verification letter or
If you have any questions, please call: (____)_____-________
618 8 2 5 - 2 7 0 4
annual Cost of Living Adjustment (COLA) letter
(only Form SSA-4926-SM-DI). If you are under the age of 65
receiving Supplemental Security Income (SSI) disability
benefits, proof includes a letter indicating SSI payments
(SSA-L8151, SSA-L8155, or SSA-L8156).
3 Proof of Veterans Administration disability benefits which
includes an award letter or verification letter indicating you are
receiving a pension for a non-service connected disability.
4 Proof of Railroad or Civil Service disability benefits which
includes an award letter or verification letter of total (100%)
disability.
Social Security Administration’s Listing of Impairments
The Listing of Impairments describes, for each major body system, impairments that are considered severe enough to prevent a
person from doing any gainful activity. Most of the listed impairments are permanent or expected to result in death, or a specific state-
ment of duration is made. For all others, the evidence must show that the impairment has lasted or is expected to last for a continuous
period of at least 12 months. The criteria in the listing of impairments are applicable to evaluation of claims for disability benefits from
the Social Security Administration (SSA). Visit SSA web site for more specific information.
1.00
8.00
Musculoskeletal System
Skin Disorders
2.00
9.00
Special Senses and Speech
Endocrine Disorders
3.00
Respiratory System
10.00
Impairments that Affect Multiple Body Systems
4.00
Cardiovascular System
11.00
Neurological
5.00
12.00
Digestive System
Mental Disorders
6.00
13.00
Genitourinary System
Malignant Neoplastic Diseases
7.00
Hematological Disorders
14.00
Immune Systems Disorders
Official use. Do not write in this space.
Date received: ___ ___/___ ___/___ ___ ___ ___
DFPR license verified: ___ ___/___ ___/___ ___ ___ ___
Month
Day
Year
Month
Day
Year
Comments:______________________________________________
_______________________________________________________
_______________________________________________________
PTAX-343-A (R-12/13)
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