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Request for Social Security Statement |
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Form SSA-7004, Request for Social Security Statement, is used to get a record of your Social Security earnings history. When we receive your request, we will send you a Statement that shows your earnings year-by-year and give you estimates of benefit payments that you and your family may qualify for now or in the future. You can make your request a Social Security Statement online, but if you prefer to mail it, you will find request form SSA-7004 below in Portable Document Format (PDF), and graphic format. The PDF permits you to print out a duplicate of the original SSA-7004 using any graphics printer. PDF was developed by Adobe Systems, Inc. and allows the reader to print a publication close in appearance to the original printed version, preserving typography, columns, charts, tables and graphics. To read and print a PDF publication, you must have the Adobe Acrobat
Reader software installed on your PC. Adobe Systems, Inc. permits the
Social Security Administration and other organizations to offer this software
to the public free of charge. You can download the Adobe Acrobat Reader
version suitable for your system by clicking on this button After you download the Adobe Acrobat Reader, come back to this page and download the PDF version of the SSA-7004 below. PDF files are printer independent and should print easily on any graphics printer (i.e., laser, inkjet). Print the form on 8 1/2 x 11 inch paper, complete and sign form, fold in thirds, insert it in a standard size number 10 business envelope (4 1/8 x 9 1/2) and mail to:
Social Security Administration
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Last reviewed or modified Wednesday Apr 01, 2009 |
