Mental Residual Functional Capacity (RFC) Assessment Form

Here is a mental RFC form for your doctor to fill out (a mental medical source statement).

By , Attorney | Updated by Diana Chaikin, Attorney
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When you apply for disability benefits due to a mental health condition, Social Security reviews your medical records and functional limitations in order to determine your mental residual functional capacity (RFC). Your mental RFC is a set of limitations on what you can and can't do in a work setting.

A typical mental RFC assessment includes whether you can do skilled, semi-skilled, or unskilled tasks, as well as whether you can work with the public, handle normal job stress, and finish your work duties on time. Depending on how severe your mental health symptoms are, your RFC might rule out all jobs, and Social Security will award you disability benefits.

What Is a Mental Residual Functional Capacity (RFC) Form?

The mental RFC form is a four- to five-page questionnaire that outlines several work-related mental functions and states how well you're able to perform them. Mental RFC forms are often completed by medical consultants, consultative examiners, or medical experts, but you can ask your own doctors to fill out a mental RFC form and submit it to Social Security.

Having a doctor, counselor, or therapist who has consistently treated you fill out a mental health RFC form can improve your chances of winning your disability case. For example, your doctor can help answer important questions such as:

  • Can you work independently or with others?
  • Can you maintain concentration or focus long enough to complete tasks?
  • Do you adapt well to changes in your work routine?
  • Would you miss too many days of work due to mental health symptoms?

Your doctor's mental RFC can also help strengthen any "weak spots" in your application, such as evidence of malingering, drug and alcohol abuse, or failure to follow prescribed treatment.

Download a Mental RFC Assessment Form PDF for Your Doctor

Below you'll see a link to a PDF of our free mental RFC assessment form. You can print it out and bring it to your doctor, psychiatrist, or psychologist. Your doctor may charge you a small fee to fill out the form, but the fee is worth it. Completing the form should take your doctor about an hour.

After you give the form to your doctor, you can either follow up to make sure your doctor sends the form to Social Security, or your doctor can return it to you (or your representative) to send in. Keep a copy for yourself—having a backup of your mental RFC can be useful in case the form gets lost in the shuffle.

Download Mental RFC Assessment Form (PDF)

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