This government document is issued by Department of Juvenile Justice for use in Georgia
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https://www.google.com/url?client=internal-element-cse&cx=450907bf5042c4844&q=https://djj.georgia.gov/document/document/standard-how-file-disability-claim/download&sa=U&ved=2ahUKEwj02efE-4yHAxXMgP0HHRp1CD44HhAWegQIBhAB&usg=AOvVaw18CzYeKNLux4DeBcBEwMsW&fexp=72519171,72519168