CPP Disability - Guide to application kit forms

Anyone who wants to apply for a CPP disability benefit, or any individual who wants to help someone apply for a CPP disability benefit must contact Service Canada to obtain the CPP disability application kit. Or, you can access and print a CPP disability application kit online. All forms must be completed in writing.

An Application Form for Disability Benefits

This form asks straightforward questions about the applicant. It is important to answer all questions completely, including name, date of birth, social insurance number, gender, address, and other information that identifies the applicant. The applicant will also be asked to provide information about children that he or she may have. If the children are considered "dependent", this is important as they may be eligible for a benefit. If the children are not in the care and custody of the applicant an additional form (Application for benefits for under age 18 children of disabled contributor - ISP 1152B) will have to be filled out. You may contact Service Canada to obtain a copy of this form.

If the children are between 18 and 25 years of age, and are attending school full-time, additional forms (Application for a Canada Pension Plan child's benefit - ISP 1400) and Declaration of Attendance at School or University - ISP 1401) will need to be filled out.

Checklist for these forms - make sure you:

• checked to make sure all information to identify the applicant has been provided;
• provided information on direct deposit if that is the payment preference;
• provided information on any children;
• included original birth certificates of children if their Social Insurance Number is not provided. (we will return these to you), or readable photocopies which have been certified as true copies of the original.

The applicant must sign these forms.

Questionnaire for Disability Benefits Form

This part of the application provides some of the information used to determine if the applicant meets the CPP definition of disability. This information, along with the Medical Report to be completed by the applicant's doctor, will be assessed to determine whether the applicant's medical condition is severe and prolonged.

It is important to provide clear and relevant detailed information. The applicant needs to provide information that describes the illnesses or impairments that prevented him or her from working, as well as engaging in other activities. This allows Service Canada to better understand the extent of the medical condition and the limitations it causes. Feel free to use additional sheets of paper to provide this information (include the applicant's social insurance number on each sheet).

Indicate the date that the applicant stopped working. It is also necessary to provide information as to why the applicant stopped working, and in particular, how the applicant's medical condition affected their employment and whether this led to the applicant not being able to work on a regular basis any more.

The applicant will also be asked to provide information on physicians seen and hospital stays over the last two years, and a list of medications and treatments.

Checklist for this form - make sure the applicant:

• signed the questionnaire;
• added his or her social insurance number on top of every page and any attached sheets;
• provided all the required information clearly and completely and has not left any questions blank. If a question is not relevant to the applicant's situation, it is best to write "not applicable" or "I don't know".

The Medical Report Form

The applicant must fill out the first section of this report which identifies the applicant by name, address, date of birth, telephone and social insurance number. The physician who is most knowledgeable about the applicant's medical condition should fill out the remainder of the report. Any additional specialists' reports are welcome and can be submitted with the application. To ensure correct file matching, it is very helpful to add the applicant's social insurance number on any attached pages from a physician.

Once the applicant's physician has filled out the Medical Report, he or she can submit it directly to Service Canada, or return it to the applicant who can include it in the CPP application kit.

Checklist for this form - make sure the applicant:

• has chosen the physician who best knows his or her medical condition to fill out the Medical Report;
• attached other supporting medical reports, tests, or other documents and include the applicant's social insurance number on each page;
• co-ordinated the submission of the Medical Report (whether to be included in the application kit or sent directly to Service Canada);
• photocopied the Medical Report for the applicant's files.

Consent for Service Canada to Obtain Personal Information

Any individual applying for a CPP disability benefit is asked to sign a release/consent form which allows Service Canada to access medical and non-medical information from various sources, such as: physicians; disability insurers; employers; and hospitals. You may print the Consent for Service Canada to Obtain Personal Information form from our Web site.

The purpose of the form is to allow the gathering of information to determine whether an applicant meets CPP disability eligibility requirements, which are related to his or her ability to work on a regular basis.

An applicant can choose not to sign the consent form and thus not authorize any further release of information. However, this means that Service Canada will make its final decision based solely on the information presented in the applicant's file, which may be insufficient to present a convincing case.

If the applicant does sign the consent form, the Privacy Act, Access to Information Act and the Canada Pension Plan legislation will protect the information received. The applicant can request access to any personal information Service Canada collects.

Checklist for this form - make sure the applicant:

• understands the purpose of the consent form;
• signs the authorization and consent form, if in agreement.

The Child Rearing Provision Form

There are two types of eligibility requirements for a CPP disability benefit: contribution eligibility requirements - the applicant has to have made enough contributions; and requirements which prove the disability is severe and prolonged.

The provision contained in this form can help the applicant meet contribution eligibility requirements for CPP disability and/or increase the monthly amount of the CPP disability benefit if the application is approved. This provision relates to periods of time when an applicant's earnings from work were low or zero because he or she was raising children under the age of seven. This period of time can be eliminated or dropped from the applicant's contributory period.

In order for Service Canada to exclude this period of time when calculating contribution eligibility requirements, the applicant must have:

1. reduced or stopped work to care for children under the age of seven and
2. been receiving Family Allowances, OR
   • been the spouse of someone receiving Family Allowances and remained at home as the primary care giver of a child, OR
   • been eligible for the Canada Child Tax Benefit, or would have been eligible had the applicant applied for the benefit and no other person was eligible for the Canada Child Tax Benefit for the same children.

To be eligible for the Canada Child Tax Benefit, an individual must have been the primary care giver of a child under seven. And the individual would have had to be living with the child and be a resident of Canada for income tax purposes.

If the applicant is not sure whether he or she meets the requirements under this form, it is recommended that they apply anyway. Service Canada can determine if the applicant qualifies. You may print the Child Rearing Provision form from our Web site.

Checklist before sending in the Application Kit forms

Checklist - make sure the applicant or the friend or family member who is helping to prepare the application:

• reads the General Information and Guide and understands them and the applicant's obligations;
• provides the required proof of birth for the applicant's children if applicable;
• adds the applicant's social insurance number on all pages, including any attached sheets;
• includes all reports and documents that support the applicant's claim;
• photocopies all information that the applicant is submitting for the applicant's own records;
• makes note of the date that the applicant is sending/submitting the application kit.

The application kit can be mailed to our offices or the application can be submitted in person at the nearest Service Canada Center. If you do submit your application forms in person, remember to bring proof of birth.

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