| SS-5 |
Application for a Social Security Card
|
| SSA-827 |
Authorization to Disclose Information to the Social Security Administration |
| SSA-1696-U4 |
Appointment of Representative |
| SSA-3820-BK |
Disability Report – Child |
| IRS W-4V |
Voluntary Withholding Request |
| CMS-40B |
Application for Enrollment in Medicare – Part B (Medical Insurance) |
| CMS-L564 |
Request for Employment Information |
| CMS-L564S |
Solicitud De Información Sobre El Empleo |
| HA-501-U5 |
Request for Hearing by Administrative Law Judge |
| HA-520-U5 |
Request for Review of Hearing Decision/Order |
| HA-539 |
Notice Regarding Substitution of Party Upon Death of Claimant |
| HA-539-SP |
Aviso Sobre La Substitución De La Parte Interesada Tras El Fallecimiento Del Reclamante |
| HA-4608 |
Waiver of Your Right to Personal Appearance Before an Administrative Law Judge |
| HA-4631 |
Claimant’s Recent Medical Treatment |
| HA-4632 |
Claimant’s Medications |
| HA-4633 |
Claimant’s Work Background |
| IRS SS-4 |
Application for Employer Identification Number |
| Online |
Adult Disability Report |
| Online |
Appeal a Recent Medical Decision |
| Online |
Apply for Disability Benefits |
| Online |
Apply for Retirement, Spouse’s or Medicare Benefits |
| Online |
Apply Online for Extra Help with Medicare Prescription Drug Plan Costs |
| Online |
Change Address or Telephone Number |
| Online |
Child Disability Report |
| Online |
Get a Replacement Medicare Card |
| Online |
Representative Payee Accounting Report |
| Online |
Request a Form SSA-1099/1042 (Benefit Statement) for tax or other purposes |
| Online |
Request a Proof of Social Security Benefits Letter |
| Online |
Request Special Notices for the Blind or Visually Impaired |
| Online |
Sign Up For or Change Direct Deposit |
| SS-5-FS |
Application for a Social Security Card (Outside of the U.S.) |
| SS-5-SP |
Solicitud para una tarjeta de Seguro Social |
| SSA-1-BK |
Application for Retirement Insurance Benefits |
| SSA-1-BK-SP |
Solicitud Para Beneficios De Seguro Por Jubliación |
| SSA-2-BK |
Application for Wife’s or Husband’s Insurance Benefits |
| SSA-2-BK-SP |
Solicitud Para Beneficios De Seguro Como Cónyuge |
| SSA-3 |
Marriage Certification |
| SSA-4-BK |
Application for Child’s Insurance Benefits |
| SSA-4-BK-SP |
Solicitud Para Beneficios De Seguro Para Niños |
| SSA-4-INST |
Reporting Responsibilities for Child’s Insurance Benefits |
| SSA-5-BK |
Application for Mother’s or Father’s Insurance Benefits |
| SSA-5-BK-SP |
Application For Mother’s Or Father’s Insurance Benefits – Spanish |
| SSA-5-INST |
Reporting Responsibilities for Mother’s or Father’s Insurance Benefits |
| SSA-7-F6 |
Application for Parent’s Insurance Benefits |
| SSA-7-F6-SP |
Application for Parent’s Insurance Benefits – Spanish |
| SSA-8 |
Application for Lump-Sum Death Payment |
| SSA-8-SP |
SOLICITUD DEL PAGO GLOBAL POR DEFUNCIÓN |
| SSA-10 |
Application for Widow’s or Widower’s Insurance Benefits |
| SSA-10-INST |
Reporting Responsibilities for Widow’s or Widower’s Insurance Benefits |
| SSA-16 |
Application for Disability Insurance Benefits |
| SSA-16-SP |
Solicitud para beneficios de seguro por incapacidad |
| SSA-16-INST |
Reporting Responsibilities For Disability Insurance Benefits |
| SSA-21 |
Supplement to Claim of Person Outside the United States |
| SSA-24 |
Application for Survivors Benefits (Payable Under Title II of the Social Security Act) |
| SSA-25 |
Certification of Election for Reduced Spouse’s Benefits |
| SSA-44 |
Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event |
| SSA-88 |
Pre-Approval Form for Consent Based Social Security Number Verification (CBSV) |
| SSA-89 |
Authorization for the Social Security Administration To Release Social Security Number (SSN) Verification |
| SSA-89-SP |
Autorización para que la Administración de Seguro Social Divulgue la Verificación de un Número de Seguro Social (SSN) |
| SSA-131 |
Employer Report of Special Wage Payments |
| SSA-150 |
Modified Benefits Formula Questionnaire |
| SSA-199 |
Vocational Rehabilitation Provider Claim |
| SSA-308 |
Modified Benefits Formula Questionnaire, Foreign Pension |
| SSA-437-BK |
Complaint Form for Allegations of Discrimination in Programs or Activities Conducted by the Social Security Administration |
| SSA-437-BK-SP |
Formulario Para Querellas De Alegaciones De Discriminación En Los Programas De La Administración Del Seguro Social |
| SSA-521 |
Request for Withdrawal of Application |
| SSA-521-SP |
Solicitud Para Revocar Una Reclamación |
| SSA-545-BK |
Plan for Achieving Self-Support |
| SSA-546 |
Worker’s Compensation/Public Disability Questionnaire |
| SSA-561-U2 |
Request for Reconsideration |
| SSA-604 |
Certificate of Incapacity |
| SSA-632-BK |
Request for Waiver of Overpayment Recovery |
| SSA-634 |
Request for Change in Overpayment Recovery Rate |
| SSA-634-SP |
Solicitud de cambio en la tasa de recuperación de sobrepago |
| SSA-640 |
Financial Disclosure for Civil Monetary Penatly (CMP) Debt |
| SSA-671 |
Railroad Employment Questionnaire |
| SSA-711 |
Request for Deceased Individual’s Social Security Record |
| SSA-714 |
You can make your payment by Credit Card |
| SSA-721 |
Statement of Death by Funeral Director |
| SSA-753 |
Statement Regarding Marriage |
| SSA-754-F5 |
Statement of Marital Relationship |
| SSA-769-U4 |
Request for Change in Time/Place of Disability Hearing |
| SSA-770-U4 |
Notice Regarding Substitution of Party Upon Death of Claimant Reconsideration of Disability Cessation |
| SSA-773-U4 |
Waiver Of Right To Appear – Disability Hearing |
| SSA-781 |
Certificate of Responsibility for Welfare and Care of Child |
| SSA-783 |
Statement Regarding Contributions |
| SSA-788 |
Statement of Care and Responsibility for Beneficiary |
| SSA-789-U4 |
Request for Reconsideration – Disability Cessation |
| SSA-795 |
Statement of Claimant or Other Persons |
| SSA-820-BK |
Work Activity Report (Self-Employed Person) |
| SSA-821-BK |
Work Activity Report |
| SSA-827-INST |
Instructions for Completing the SSA-827 |
| SSA-827-INST-SP |
Instrucciones para completar el formulario SSA-827 |
| SSA-1020-INST |
General Instructions for Completing the Application for Extra Help with Medicare Prescription Drug Plan Costs |
| SSA-1021 |
Appeal of Determination for Extra Help with Medicare Prescription Drug Plan Costs |
| SSA-1021-SP |
Apelación de la determinación para recibir el Beneficio Adicional con los gastos del plan de medicamentos recetados de Medicare |
| SSA-1021-INST |
Instructions for Completing the Appeal of Determination for Extra Help with Medicare Prescription Drug Plan Costs |
| SSA-1021-INST-SP |
Instrucciones para llenar la apelación de la determinación para recibir el beneficio adicional con los gastos del plan de medicamentos recetados de Medicare |
| SSA-1199 |
International Direct Deposit (IDD) |
| SSA-1372-BK |
Advanced Notice of Termination of Child’s Benefits |
| SSA-1372-BK-FC |
Advanced Notice of Termination of Child’s Benefits (Foreign Claims) |
| SSA-1372-BK-FC-SP |
Adviso Por Adelantado De Cese De Beneficios Para Niños |
| SSA-1383 |
Student Reporting Form |
| SSA-1383-FC |
Reporting to Social Security Administration by Student Outside the United States |
| SSA-1414 |
Credit Card Payment Form |
| SSA-1458 |
Certification By Religious Group |
| SSA-1560 |
Petition For Authorization To Charge And Collect A Fee For Services Before The Social Security Administration |
| SSA-1693 |
Fee Agreement for Representation Before the Social Security Administration |
| SSA-1694 |
Request for Business Entity Taxpayer Information |
| SSA-1695-F3 |
Identifying Information for Possible Direct Payment of Authorized Fees |
| SSA-1696-SUP1 |
Claimant’s Revocation of the Appointment of a Representative |
| SSA-1696-SUP2 |
Representative’s Withdrawal of Acceptance of Appointment |
| SSA-1699 |
Registration for Appointed Representative Services and Direct Payment |
| SSA-1724-F4 |
Claim for Amounts due in case of a Deceased Beneficiary |
| SSA-1945 |
Statement Concerning Your Employment in a Job Not Covered by Social Security |
| SSA-2010-F6 |
Statement for Determining Continuing Entitlement for Special Veterans Benefits (SVB) |
| SSA-2032-BK |
Request for Waiver of Special Veterans Benefits (SVB) Overpayment Recovery or Change in Repayment Rate |
| SSA-2512 |
Pre-1957 Military Service Federal Benefit Questionnaire |
| SSA-2519 |
Child Relationship Statement |
| SSA-2855 |
Statement of Funds you Received |
| SSA-3033 |
Employee Work Activity Questionnaire |
| SSA-3105 |
Important information about your appeal, waiver rights, and repayment options |
| SSA-3194 |
Permanent Medical Parking Renewal Certification |
| SSA-3288 |
Consent for Release of Information |
| SSA-3288-SP |
Consentimiento para divulgar información |
| SSA-3368-BK |
Disability Report – Adult |
| SSA-3369-BK |
Work History Report |
| SSA-3373-BK |
Function Report – Adult |
| SSA-3375-BK |
Function Report – Child Birth to 1st Birthday |
| SSA-3376-BK |
Function Report – Child Age 1 to 3rd Birthday |
| SSA-3377-BK |
Function Report – Child Age 3 to 6th Birthday |
| SSA-3378-BK |
Function Report – Child Age 6 to 12th Birthday |
| SSA-3379-BK |
Function Report – Child Age 12 to 18th Birthday |
| SSA-3380-BK |
Function Report – Adult – Third Party Form |
| SSA-3441-BK |
Disability Report – Appeal |
| SSA-3881-BK |
Questionnaire for Children Claiming SSI Benefits |
| SSA-3885 |
Government Pension Questionnaire |
| SSA-4111 |
Certification of Election for Reduced Widow(er)’s and Surviving Divorced Spouse’s Benefits |
| SSA-4162 |
Child Care Dropout Questionnaire |
| SSA-4814 |
Medical Report on Adult with Allegation of Human Immunodeficiency Virus (HIV) Infection |
| SSA-4815 |
Medical Report on Child with Allegation of Human Immunodeficiency Virus (HIV) Infection |
| SSA-5062 |
Claimant’s Statement about Loan of Food or Shelter |
| SSA-5665-BK |
Teacher Questionnaire |
| SSA-5666 |
Request for Administrative Information |
| SSA-7008 |
Request for Correction of Earnings Record |
| SSA-7050-F4 |
Request for Social Security Earnings Information |
| SSA-7104 |
Partnership Questionnaire |
| SSA-7156 |
Farm Self Employment Questionnaire |
| SSA-7157-F4 |
Farm Arrangement Questionnaire |
| SSA-7160 |
Employment Relationship Questionnaire |
| SSA-7163 |
Questionnaire about Employment or Self Employment |
| SSA-7163A-F4 |
Supplemental Statement Regarding Farming Activities |
| SSA-8240 |
Authorization for the Social Security Administration to Obtain Wage and Employment Information from Payroll Data Providers |
| SSA-8510 |
Authorization for the Social Security Administration to Obtain Personal Information |
| SSA-L447 |
Medicare Savings Programs Eligible Letters |
| SSA-L447-SP |
Cartas para saber si tiene derecho al Programa de ahorros de Medicare |
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