Borrowers use this U.S. Department of Education application to have Direct, FFEL and Perkins loans and TEACH Grant service obligations discharged for total and permanent disability. A clinician meets it when a patient without qualifying VA or SSA documentation needs a medical certification in Section 6. The borrower then has 90 days from the clinician's signature to get it to the Department's TPD servicer.
The borrower completes Sections 3 to 5. Section 6, the Authorized Medical Professional Certification, is completed by an MD or DO legally authorized to practice in a state, a state-licensed NP or PA, or a certified psychologist at the independent practice level licensed in the United States.
The opening page explains the standard: the applicant must be unable to engage in any substantial gainful activity because of a medically determinable physical or mental impairment that can be expected to result in death, has lasted at least 60 continuous months, or is expected to last at least 60 continuous months. It lists who may certify and instructs you to complete items 1 through 11, print legibly, initial any changes, and use no abbreviations or insurance codes.
Enter the applicant's name and date of birth. The header of each page also carries the borrower's name and Social Security number from Section 3, and the certification on page 8 refers back to the applicant identified in this item, so the details must match.
Item 2 asks whether a medically determinable impairment prevents any substantial gainful activity; if the applicant can do such work in any field, answer No and stop. Item 3 asks whether the impairment is expected to result in death (Yes skips to item 5). Item 4 asks whether it has lasted or is expected to last at least 60 continuous months; No ends the application.
Write out the diagnosis of the applicant's impairment in words. The form repeats that insurance codes and abbreviations must not be used here, so spell out each condition rather than listing ICD codes or shorthand. Reviewers read this together with items 6 to 11 to judge whether the disabling standard is met.
Describe how severe the impairment is, including the phase of the condition where that applies, for example the stage or progression of the disease. The Department's guidance to medical professionals says the certification should show whether an impairment exists, how severe it is and how long it will last, with comments on diagnosis, severity and functional limits.
Explain how the condition prevents substantial gainful activity in any field of work: limitations on sitting, standing, walking or lifting (7); activities of daily living (8); residual functionality (9); social or behavioral limitations (10); and a Global Assessment of Functioning score for psychiatric conditions (11). Enter N/A where an item does not apply, attach pages if needed, and add medications or procedures that help explain the condition.
Sign the statement that, in your best professional judgment, the applicant has an impairment consistent with items 2 through 11. Check your credential (MD, DO, NP, PA or certified psychologist), give the state where you are authorized or licensed and your license number, which is subject to verification and may be stamped. Sign by hand, since a stamp is not accepted for the signature, then add the date, printed name, address, email, phone and fax.
Download the current version from the source each time; forms change without notice.
Discharge Application: Total And Permanent Disability
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Sources for this guide
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Section 6 can be signed by an MD or DO legally authorized to practice in a state, a nurse practitioner or physician assistant licensed by a state, or a certified psychologist at the independent practice level licensed in the U.S. State includes D.C., Puerto Rico, Guam and other listed territories; licensees there attach a copy of their license showing its expiration date.
The borrower must submit the application to the Department of Education within 90 days of the date of the medical professional's signature in Section 6. After that, a new certification is needed. If an application is denied, the borrower can ask for re-evaluation with new information within 12 months without filing a new application.
The form defines it as a level of work performed for pay or profit that involves significant physical or mental activities, or both. The applicant does not have to be unable to work at all. If they can engage in any substantial gainful activity in any field of work, the clinician must answer No to item 2.
Not if their SSA notice of award or Benefits Planning Query shows a qualifying status: next disability review set 5 to 7 years out, a review scheduled at 3 years, an onset date or SSDI or SSI receipt of at least 5 years, a compassionate allowance, or retirement benefits after meeting one of these.