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Nevada 2941-EF Medical Provider ABAWD Attestation

Nevada's Division of Social Services sends this two-page attestation when a SNAP recipient subject to the able-bodied adult (ABAWD) work requirement says a health condition limits their ability to work. It asks only one thing: whether the person can take part in work activities totaling 80 hours a month, roughly 20 hours a week, and for how long any limitation will last.

Who completes it

A licensed medical professional completes the Medical Provider Statement, with practice name, phone, signature and date. DSS fills in the case name, case ID and the individual's name and address at the top.

Submitting and payment

How to submit it
Return the completed attestation to the Nevada Division of Social Services by mail or email, using the contact details printed in the form's footer.

Good to know

  • DSS states it does not require a diagnosis, treatment records or detailed medical history, only information needed to assess functional work capacity.
  • Choose one of three statements: able to do 80 hours a month, unable to do 80 hours a month, or has limitations affecting work capacity.
  • If unable or limited, mark the condition temporary, permanent or indeterminate, and give an anticipated duration when it is temporary or indeterminate.
  • The current edition is 2941-EF (03/26), new in 2026; a Spanish version, 2941-EFS, is posted alongside it.

Get the official form

Download the current version from the source each time; forms change without notice.

Medical Provider ABAWD Attestation

Official pagePDFVersión en español

How this list is checked

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.

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Frequently asked questions

Do I have to give a diagnosis on Nevada form 2941-EF?

No. The form says DSS does not require diagnosis, treatment records or detailed medical history. It asks for a brief lay description of the functional limitation and says not to include a diagnosis unless necessary, plus any additional relevant functional information.

What does 80 hours a month mean on the ABAWD attestation?

DSS is checking whether the person can participate in work activities totaling 80 hours per month, about 20 hours a week, which is the SNAP work participation level for certain adults. You mark whether they are able, unable, or limited.

Is form 2941-EF available in Spanish?

Yes. Nevada DSS posts a Spanish version, 2941-EFS, dated 03/2026 like the English form, on its applications and forms page. Both ask the same questions about capacity for 80 hours a month of work activities.