Pennsylvania Physician's Statement of Permanent and Total Disability (PA Property Tax/Rent Rebate)
Extracted from PDF file 2023-pennsylvania-form-pa-1000-ps.pdf, last modified November 2011Physician's Statement of Permanent and Total Disability (PA Property Tax/Rent Rebate)
IMPORTANT: FILL IN FORM MUST BE DOWNLOADED ONTO YOUR COMPUTER PRIOR TO COMPLETING PHYSICIAN’S STATEMENT 2305310050 Physician’s Statement of Permanent and Total Disability PA-1000 PS 03-23 (FI) PA Department of Revenue 2023 OFFICIAL USE ONLY START Name as shown on PA-1000 Social Security Number ➜ Instructions A claimant not covered under the federal Social Security Act or the federal Railroad Retirement Act who is unable to submit proof of permanent and total disability may submit this Physician’s Statement. The physician must determine the claimant’s status using the same standards used for determining permanent and total disability under the federal Social Security Act or the federal Railroad Retirement Act. CAUTION: If the claimant applied for Social Security disability benefits and the Social Security Administration did not rule in the claimant’s favor, the claimant is not eligible for a Property Tax or Rent Rebate. Confidentiality Statement. All information on this Physician’s Statement and claim form is confidential. The department shall only use this information for the purposes of determining the claimant’s eligibility for a Property Tax or Rent Rebate. CERTIFICATION I certify the claimant named above is my patient and is permanently and totally disabled under the standards that the federal Social Security Act or the federal Railroad Retirement Act requires for determining permanent and total disability. Upon request from the PA Department of Revenue, I will provide the medical reports or records indicating diagnosis and prognosis of the claimant’s condition, including signs, symptoms and laboratory findings, if applicable or appropriate. Please sign after printing. Physician Signature Date MM/DD/YY Description of Claimant’s Permanent and Total Disability. Briefly describe the reason(s) the above-named claimant is totally and permanently disabled. Physician Identification Information. Please print. Name National Provider Identifier Business name, if applicable Address City State Office telephone number Office email address 2305310050 Reset Entire Form ZIP Code 2305310050 TOP OF PAGE PRINT
2023 Physician's Statement - Physician's Statement of Permanent and Total Disability (PA-1000 PS)
More about the Pennsylvania Form PA-1000 PS Individual Income Tax TY 2023
We last updated the Physician's Statement of Permanent and Total Disability (PA Property Tax/Rent Rebate) in January 2024, so this is the latest version of Form PA-1000 PS, fully updated for tax year 2023. You can download or print current or past-year PDFs of Form PA-1000 PS directly from TaxFormFinder. You can print other Pennsylvania tax forms here.
Related Pennsylvania Individual Income Tax Forms:
TaxFormFinder has an additional 174 Pennsylvania income tax forms that you may need, plus all federal income tax forms. These related forms may also be needed with the Pennsylvania Form PA-1000 PS.
Form Code | Form Name |
---|---|
Form PA-1000 | Property Tax or Rent Rebate Claim |
Form PA-1000 Booklet | Property Tax or Rent Rebate Program Instruction Booklet |
Form PA-1000 RC | PA Rent Certificate - PA Rent Certificate and Rental Occupancy Affidavit (PA Property Tax/Rent Rebate) |
Form PA-1000 B/D/E | Widow or Widower/Public Assistance/Business Use Prorations (PA Property Tax/Rent Rebate) |
Form PA-1000 F/G | Multiple Owner or Lessor Prorations/Income Annualization (PA Property Tax/Rent Rebate) |
Form PA-1000 A | Deceased Claimant and/or Multiple Home Prorations (PA Property Tax/Rent Rebate) |
View all 175 Pennsylvania Income Tax Forms
Form Sources:
Pennsylvania usually releases forms for the current tax year between January and April. We last updated Pennsylvania Form PA-1000 PS from the Department of Revenue in January 2024.
About the Individual Income Tax
The IRS and most states collect a personal income tax, which is paid throughout the year via tax withholding or estimated income tax payments.
Most taxpayers are required to file a yearly income tax return in April to both the Internal Revenue Service and their state's revenue department, which will result in either a tax refund of excess withheld income or a tax payment if the withholding does not cover the taxpayer's entire liability. Every taxpayer's situation is different - please consult a CPA or licensed tax preparer to ensure that you are filing the correct tax forms!
Historical Past-Year Versions of Pennsylvania Form PA-1000 PS
We have a total of three past-year versions of Form PA-1000 PS in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:
2023 Physician's Statement - Physician's Statement of Permanent and Total Disability (PA-1000 PS)
2022 Physician's Statement - Physician's Statement of Permanent and Total Disability (PA-1000 PS)
2021 Physician's Statement - Physician's Statement of Permanent and Total Disability (PA-1000 PS)
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