Form DR-416, the Physician's Certification of Total and Permanent Disability, is the statement a licensed Florida physician signs to certify that a person is totally and permanently disabled as of January 1. It is one of the forms involved in an Osceola County property tax exemption claim, where the taxpayer presents it to the county property appraiser; the Osceola County Property Appraiser publishes the PDF. On this page you can fill out the form online on FillingPDF and download or print the completed PDF.
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What is DR-416?
Form DR-416, Physician's Certification of Total and Permanent Disability, is the Florida form on which a licensed physician certifies that a named person is totally and permanently disabled as of January 1, and states the condition that causes the disability.
The form cites Rule 12D-16.002 of the Florida Administrative Code and carries the revision mark R. 11/12. The physician states that he or she is licensed under Chapter 458 or Chapter 459, Florida Statutes, identifies the patient, and checks the qualifying condition: quadriplegia, paraplegia, hemiplegia, legal blindness, or another total and permanent disability requiring use of a wheelchair for mobility. A separate box covers a patient who is totally or permanently disabled but does not require a wheelchair for mobility.
The physician then confirms that the conditions make the person totally and permanently disabled and that the statements are true, correct and complete to the best of his or her knowledge and professional belief. The form ends with the physician's signature, date, printed address, Florida Board of Medicine or Osteopathic Medicine license number and the date that license was issued.
The form is a certification, not an application. The taxpayer presents it to the county property appraiser in support of a total and permanent disability exemption. The form also says that a letter from the United States Department of Veterans Affairs or its predecessor can be presented instead of this form.
Who needs to file DR-416?
Each Florida resident applying for a total and permanent disability exemption must present to the county property appraiser either a copy of Form DR-416 or a letter from the United States Department of Veterans Affairs or its predecessor. The form notes that it is to be completed by a licensed Florida physician.
Two people take part:
- The taxpayer (the disabled person) supplies his or her name and Social Security number and presents the completed form to the property appraiser.
- The physician must be licensed under Chapter 458 or Chapter 459, Florida Statutes. The physician completes the certification, signs it and gives the Florida Board of Medicine or Osteopathic Medicine license number.
You do not need this form if you present a letter from the United States Department of Veterans Affairs or its predecessor instead. The form does not describe who may sign or present it for someone else, so ask the property appraiser's office about representatives.
When to file DR-416
Present Form DR-416 to the county property appraiser on or before March 1 of each year. The form's notice to the taxpayer states the March 1 date and applies it to each Florida resident applying for a total and permanent disability exemption.
The certification speaks as of January 1: the physician states that the person is totally and permanently disabled as of January 1 and enters the year on the form. Arrange the physician's signature early enough to meet the March 1 date. The form prints no processing time.
Documents you need
- A copy of the completed and signed Form DR-416, presented to the county property appraiser on or before March 1, unless you present a Department of Veterans Affairs letter instead.
- A letter from the United States Department of Veterans Affairs or its predecessor, accepted in place of this form.
How to fill out DR-416
Enter the physician's name
In the opening statement, enter the physician's name. The physician must be licensed under Chapter 458 or Chapter 459, Florida Statutes.
Select the patient's title and name
Check Mr., Mrs., Miss or Ms., then enter the name of the totally and permanently disabled person.
Enter the Social Security number
Enter the patient's Social Security number in the space marked with an asterisk. The form states that disclosure is mandatory.
Enter the January 1 year
Complete the statement that the person is totally and permanently disabled as of January 1 by entering the year.
Check the qualifying condition
Check quadriplegia, paraplegia, hemiplegia, legal blindness, or other total and permanent disability requiring use of a wheelchair for mobility. If the patient is totally or permanently disabled but does not require a wheelchair, check that separate box.
Confirm the patient's title again
In the professional belief statement, check Mr., Mrs., Miss or Ms. again so it matches the patient.
Sign and date the certification
The physician signs and dates the form, confirming the statements are true, correct and complete to the best of his or her knowledge and professional belief.
Print the physician's address
Enter the street, city, state and ZIP code of the physician.
Enter the license number
Enter the Florida Board of Medicine or Osteopathic Medicine license number and the date it was issued.
Review and download the completed PDF
Check every entry and the signature, then download or print the completed PDF from FillingPDF and present a copy to the county property appraiser on or before March 1.
How to submit DR-416
You present Form DR-416 to the county property appraiser. For Osceola County, that is the Osceola County Property Appraiser, which publishes the form.
- Who presents it: the taxpayer presents a copy of the completed, signed form to the county property appraiser on or before March 1 of each year.
- Alternative: a letter from the United States Department of Veterans Affairs or its predecessor can be presented in place of the form.
- Address, portal and hours: the form prints none. Contact the property appraiser's office for how it accepts the form.
The form names no fee. FillingPDF lets you fill out and download the PDF; submission follows the property appraiser's channels described above.
Common mistakes to avoid
- Having the form completed by a physician who is not licensed in Florida; the form says it is to be completed by a licensed Florida physician under Chapter 458 or Chapter 459.
- Presenting the form to the county property appraiser after March 1 of the year.
- Leaving out the Social Security number; the form states that disclosure is mandatory.
- Leaving the January 1 year blank, so the certification does not say as of which date the disability applies.
- Checking the wheelchair condition box when the patient does not require a wheelchair, instead of the separate box for that case.
- Submitting the form without the physician's signature, date or printed address.
- Omitting the Florida Board of Medicine or Osteopathic Medicine license number or the date it was issued.
- Giving false information to claim a homestead exemption; section 196.131(2), Florida Statutes, makes this a first-degree misdemeanor.
Frequently asked questions
What is Form DR-416 used for?
Form DR-416 is the Physician's Certification of Total and Permanent Disability. A licensed Florida physician completes it to certify that a person is totally and permanently disabled as of January 1, and the taxpayer presents it to the county property appraiser when applying for a total and permanent disability exemption.
Who has to fill out Form DR-416?
A physician licensed under Chapter 458 or Chapter 459, Florida Statutes, certifies the disability, signs the form and gives his or her Florida license number. The form says each form is to be completed by a licensed Florida physician, not by the taxpayer.
When is Form DR-416 due?
The taxpayer must present it to the county property appraiser on or before March 1 of each year. The notice printed on the form applies that date to every Florida resident applying for a total and permanent disability exemption.
Do I need a wheelchair to qualify on Form DR-416?
No. The form lists wheelchair-related conditions, but it also has a separate box for a patient who is totally or permanently disabled and does not require a wheelchair for mobility. The physician checks the box that fits the patient.
Is a Social Security number required on Form DR-416?
Yes. The form states that disclosure is mandatory under sections 196.011(1) and 196.101(5), Florida Statutes, and that the number is used to verify taxpayer identity and homestead exemption information submitted to property appraisers.
Can I give a Veterans Affairs letter instead of Form DR-416?
Yes. The form says a Florida resident may present either a copy of this form or a letter from the United States Department of Veterans Affairs or its predecessor to the county property appraiser.
What happens if false information is given on this form?
Section 196.131(2), Florida Statutes, as quoted on the form, makes it a first-degree misdemeanor to knowingly and willfully give false information to claim a homestead exemption. The penalty can be up to 1 year of imprisonment, a fine, or both. The notice applies to both taxpayer and physician.
Can I fill out Form DR-416 online on FillingPDF?
You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service and does not file the form; the taxpayer presents it to the county property appraiser.
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