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Have you lost SSI, Social Security disability, or retirement benefits because of a PROBATION or PAROLE VIOLATION WARRANT?
In April 2012 in the class action lawsuit Clark v. Astrue, the court ordered the Social Security Administration (SSA) to change its policies – SSA can no longer deny benefits to people based solely on an outstanding probation or parole violation warrant.
Who is affected by this court order?
Managing Attorney: Bethany Roberts
► This form is available to print in PDF or Word format at the bottom of this page.
REPORT OF EXAMINATION AND EVALUATION
By a □ physician □ psychologist □ social worker □ other: _____________________________ (In compliance with K.S.A. 59-3064)
Attach additional sheets as necessary.
(1) Date/Location of examination:_______________ , at ______________
(2) Name of proposed ward/conservatee:__________________________
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