Checklist For Total and Permanent Disability Discharge Application 

Borrower Signature (Section 3 of application): 

____    Did you provide your signature and date on your application?   

            Please submit the completed application with an original signature to your loan holder. You may provide a copy of the discharge application, but each copy must bear an original borrower signature. (See Section 2: Instructions for Completing and Submitting This Application) 

If you are a veteran, please review the following: 

Veteran borrowers will be considered totally and permanently disabled for purposes of this discharge if they provide documentation from the U.S. Department of Veterans Affairs (VA) showing that they have been determined to be unemployable due to a service-connected disability.  

____  Did you provide a VA Rating Decision or a letter from the VA confirming that the veteran has      
         received one of the qualifying ratings (100% disabled due to one or more service-connected
         disability conditions or individual unemployability)? 

____  Did you complete Sections 1 and 3 of the TPD Discharge Application?  

Physician’s Certification (Section 4 of application- required for applicants other than those with VA Rating Decision documentation).  Did your doctor: 

____     Answer “Yes” to Question 1? If he or she checked “No,” the application should not be submitted to your loan holder.  If he or she failed to check a box, or checked both boxes, your application will be denied.  

____    Use abbreviations or insurance codes? (See Question 2. Disabling Condition) If so, your application may be denied. 

____    Explain in detail how the illness prevents you from working or earning money? (See Question 3. Limitations)  If not, your application may be denied.  For example, it’s important not to simply restate the diagnosis. The severity of the disabling medical condition should describe the phase of a progressive disease, the duration of the disabling condition, attempted surgeries or treatments, pervasiveness of the disease or injury, and the level of pain suffered. 

____    Complete all dates? If not, your application may be denied. 

____    Indicate the type of medicine he or she practices? (See Physician’s Certification page 2) If not, your application will be denied.  Only a doctor of medicine or osteopathy is acceptable for certifying information on this form.  A nurse practitioner or physician assistant may not certify this form.  This box must be checked, even if the doctor indicates elsewhere on the application that they are an M.D. or D.O. 

____    Provide the state(s) in which they are legally authorized to practice?  If not, your application will be denied.  Although their address may be indicated elsewhere on the application, the doctor must provide the state in which they are licensed to practice medicine as an M.D. or D.O. 

____    Provide his or her professional license number?  If not, your application will be denied. 

____    Sign and date the form? If not, your application will be denied.        

____    Print his or her full name? If not, your application will be denied. 

____    Provide his or her full mailing address and telephone number?  If not, your application may be denied.