Utah's General Assistance program gives time-limited cash help to single adults and couples without dependent children who cannot work. Applicants must verify an impairment that prevents basic work activities in any occupation, meaning they cannot work any hours, and that lasts at least 60 days from the application date. Form 1GA is how a health care professional verifies it.
A health care professional who meets the credentials in DWS policy, such as a physician, APRN, physician assistant or psychologist, completes and signs the verification. DWS issues the form for the applicant's General Assistance case.
Download the current version from the source each time; forms change without notice.
General Assistance - Evidence of Impairment
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A health care professional who meets the credentials listed in DWS policy. These include physicians, advanced practice registered nurses, physician assistants and psychologists. DWS says the professional must meet those credentials for the evidence of impairment to count.
It must prevent basic work activities in any occupation, which DWS explains as not being able to work any hours at all in any occupation, and it must last 60 days or longer from the date of application.
DWS does not post a public PDF; the form is issued for the individual's General Assistance case. Once completed, it can be returned through the customer's myCase account, by mail or by fax to DWS eligibility services.