FORM NAME |
FORM # |
AGENCY |
TYPE |
Social Security Address Change Instructions
|
SSA
0000
|
SSA
|
Both Form and Instructions
|
Application for Retirement Insurance Benefits
|
SSA
1
|
SSA
|
Both Form and Instructions
|
Application for Widow's or Widower's Insurance Benefits
|
SSA
10
BK
|
SSA
|
Instructions Only
|
Statement of Agricultural Employer (Years Prior to 1988)
|
SSA
1002
F3
|
SSA
|
Both Form and Instructions
|
Statement of Agricultural Employer (1988 and Later)
|
SSA
1003
F3
|
SSA
|
Both Form and Instructions
|
Request To Be Selected As Payee
|
SSA
11
BK
|
SSA
|
Both Form and Instructions
|
Subpoena, Disability Hearing
|
SSA
1272
U4
|
SSA
|
Form Only
|
Application for U.S. Benefits under the Canada-U.S. International Agreement
|
SSA
1294
F6-CN
|
SSA
|
Both Form and Instructions
|
Employer Report of Special Wage Payments
|
SSA
131
|
SSA
|
Both Form and Instructions
|
Chinese Custom Marriage Statement --- Statement Regarding Chinese Custom Marriage
|
SSA
1344
|
SSA
|
Form Only
|
Chinese Custom Marriage Statement --- Statement Regarding Chinese Custom Marriage
|
SSA
1345
|
SSA
|
Form Only
|
State Agency Ticket Assignment Form
|
SSA
1365
|
SSA
|
Both Form and Instructions
|
State Vocational Information Sheet
|
SSA
1366
F3
|
SSA
|
Form Only
|
Individual Work Plans (IWP)
|
SSA
1367
F3
|
SSA
|
Form Only
|
Statement to U.S. Social Security Administration by School Outside the U.S. About Student's Attendance
|
SSA
1371
FC
|
SSA
|
Form Only
|
Statement to U.S. Social Security Administration by School Outside the U.S. About Student's Attendance
|
SSA
1371
|
SSA
|
Form Only
|
Advance Notice of Termination of a Child's Benefits & Student's Statement Regarding School Attendance
|
SSA
1372
BK
|
SSA
|
Form Only
|
Student Reporting Form
|
SSA
1383
|
SSA
|
Form Only
|
Credit Card payment Form
|
SSA
1414
|
SSA
|
Form Only
|
Reporting Changes that Affect Your Social Security Payment
|
SSA
1425
|
SSA
|
Form Only
|
Certification by a Religious Group
|
SSA
1458
|
SSA
|
Form Only
|
Benefits Formula Questionnaire
|
SSA
150
|
SSA
|
Form Only
|
Application for Search of Census Record for Proof of Age
|
SSA
1535
U3
|
SSA
|
Form Only
|
Petition to Obtain Approval of a Fee for Representing a Claimant before the Social Security Administration
|
SSA
1560
U4
|
SSA
|
Both Form and Instructions
|
Beneficiary Recontact Report
|
SSA
1587
OCR-SM
|
SSA
|
Both Form and Instructions
|
Beneficiary Recontact Report
|
SSA
1588
OCR-SM
|
SSA
|
Form Only
|
Application for Disability Insurance Benefits
|
SSA
16
BK
|
SSA
|
Both Form and Instructions
|
Appointment of Representative
|
SSA
1696
U4
|
SSA
|
Both Form and Instructions
|
Claim for Amounts Due in Case of a Deceased Beneficiary
|
SSA
1724
|
SSA
|
Form Only
|
Application for Special Age 72-Or-Over Monthly Payments
|
SSA
19
F6
|
SSA
|
Form Only
|
Vocational Rehabilitation Provider Claim -- 20 CFR Subpart V Subpart V
|
SSA
199
|
SSA
|
Form Only
|
Application for Wife's or Husband's Insurance
|
SSA
2
BK
|
SSA
|
Both Form and Instructions
|
Application for Special Benefits for World War II Veterans
|
SSA
2000
F6
|
SSA
|
Form Only
|
Representative Payee Report -- Special Veterans
|
SSA
2001
|
SSA
|
Both Form and Instructions
|
Supplement to Claim of Person Outside the United States
|
SSA
21
|
SSA
|
Form Only
|
Application for Survivor's Benefits
|
SSA
24
|
SSA
|
Form Only
|
Statement Regarding Student's Attendance
|
SSA
2434
F3
|
SSA
|
Form Only
|
Application for Benefits Under a U.S. International Social
|
SSA
2490
BK
|
SSA
|
Form Only
|
Certificate of Election for Reduced Spouse's Benefits
|
SSA
25
|
SSA
|
Form Only
|
Psychiatric Review Technique
|
SSA-
2506
-BK
|
SSA
|
Form Only
|
Pre-1957 Military Service Federal Benefit Questionnaire
|
SSA
2512
|
SSA
|
Form Only
|
Child Relationship Statement
|
SSA
2519
|
SSA
|
Form Only
|
Application for Benefits, Italy-U.S.A. Agreement on Social Security
|
SSA
2528
F4-IT
|
SSA
|
Both Form and Instructions
|
Information About Joint Checking/Savings Account
|
SSA
2574
|
SSA
|
Form Only
|
Statement of Funds You Provided to Another Statement of Funds You Received
|
SSA
2854
|
SSA
|
Form Only
|
Statement of Funds You Provided to Another Statement of Funds You Received
|
SSA
2855
|
SSA
|
Form Only
|
Inquiry to File an SSI Child's Application
|
SSA
293
|
SSA
|
Form Only
|
RSI/DI Quality Review Case Analysis - Sampled Number Holder
|
SSA
2930
BK
|
SSA
|
Form Only
|
RSI/DI Quality Review Case Analysis - Sampled Number Holder
|
SSA
2931
BK
|
SSA
|
Form Only
|
RSI/DI Quality Review Case Analysis - Sampled Number Holder
|
SSA
2932
BK
|
SSA
|
Form Only
|
Marriage Certification
|
SSA
3
|
SSA
|
Form Only
|
Employee Work Activity Report
|
SSA
3033
|
SSA
|
Form Only
|
Modified Benefit Formula Questionnaire, Foreign Pension
|
SSA
308
|
SSA
|
Form Only
|
Medical Parking Application
|
SSA
3192
F4
|
SSA
|
Both Form and Instructions
|
Beneficiary Interview & Auditor's Observations
|
SSA
322
|
SSA
|
Form Only
|
Privacy and Disclosure of Official Records and Information
|
SSA
3288
|
SSA
|
Both Form and Instructions
|
Disability Report, Adult
|
SSA
3368
BK
|
SSA
|
Both Form and Instructions
|
Work History Report
|
SSA
3369
BK
|
SSA
|
Both Form and Instructions
|
Function Report - Adult Third Party
|
SSA
3380
BK
|
SSA
|
Both Form and Instructions
|
Disability Report - Appeal
|
SSA
3441
BK
|
SSA
|
Both Form and Instructions
|
Disability Report--Appeal (i3441--Revisions to the Screening Questions for Use with the New iAppeals Program)
|
i
3441
(iAppeals)
|
SSA
|
Both Form and Instructions
|
Disability Report--Appeal
|
i
3441
|
SSA
|
Both Form and Instructions
|
Disability Report--Appeal (EDCS Screens)
|
SSA-
3441
-BK (EDCS Screens)
|
SSA
|
Form Only
|
Disability Report, Child
|
SSA
3820
BK
|
SSA
|
Both Form and Instructions
|
Questionnaire for Children Claiming SSI Benefits
|
SSA
3881
BK
|
SSA
|
Form Only
|
Government Pension Questionnaire
|
SSA
3885
|
SSA
|
Form Only
|
State Contribution Return
|
SSA
3961
|
SSA
|
Both Form and Instructions
|
Employee Identification Statement
|
SSA
4156
|
SSA
|
Form Only
|
Child Care Drop Out Years
|
SSA
4162
|
SSA
|
Form Only
|
Marital Relationship Questionnaire
|
SSA
4178
|
SSA
|
Form Only
|
Self-Employment-Cooperative Officer Questionnaire
|
SSA
4184
0
|
SSA
|
Form Only
|
Claimant's Recent Medical Treatment
|
SSA
4290
|
SSA
|
Form Only
|
Discrimination Complaint Form
|
SSA
437
BK
|
SSA
|
Both Form and Instructions
|
State Agency Report of Obligations for SSA Disability Programs
|
SSA
4513
|
SSA
|
Both Form and Instructions
|
State Agency Report of Obligations for SSA Disability Programs
|
SSA
4514
|
SSA
|
Both Form and Instructions
|
Report of Continuing Disability Interview
|
SSA
454
BK
|
SSA
|
Form Only
|
Disability Update Report
|
SSA
455
|
SSA
|
Form Only
|
You Can Make Your Payment by Credit Card
|
SSA
4588
OP6
|
SSA
|
Both Form and Instructions
|
You Can Make Your Payment by Credit Card
|
SSA
4589
OP6
|
SSA
|
Both Form and Instructions
|
Waiver of Your Right to Personal Appearance - Hearing
|
HA
4608
|
SSA
|
Form Only
|
Claimant's Recent Medical Treatment
|
HA
4631
|
SSA
|
Form Only
|
Claimant's Medications
|
HA
4632
|
SSA
|
Form Only
|
Claimant's Work Background
|
HA
4633
|
SSA
|
Form Only
|
Authorization for the Social Security Administration to Obtain Records from a Financial Institution and Request for Records
|
SSA
4641
U2
|
SSA
|
Form Only
|
RSI/DI Quality Review Case Analysis - Sampled Number Holder
|
SSA
4659
F4
|
SSA
|
Form Only
|
Application for a Social Security Card
|
SS
5
|
SSA
|
Both Form and Instructions
|
Application for Mother's or Father's Insurance Benefit
|
SSA
5
F6
|
SSA
|
Instructions Only
|
Request for Hearings by Administrative Law Judge
|
HA
501
U5
|
SSA
|
Form Only
|
Claimant's Statement About Loan of Food or Shelter Statement About Food or Shelter Provided to Another
|
SSA
5062
|
SSA
|
Form Only
|
Request to Resolve Questionable Quarters of Coverage (QC)
|
SSA
512
|
SSA
|
Form Only
|
Request to Resolve Questionable Quarters of Coverage (QC)
|
SSA
513
|
SSA
|
Form Only
|
Request for Review of Hearing Decision/Order
|
HA
520
U5
|
SSA
|
Form Only
|
Request for Withdrawal of Application
|
SSA
521
|
SSA
|
Form Only
|
Notice Regarding Substitution of Party Upon Death of Claimant
|
HA
539
|
SSA
|
Form Only
|
Plan for Achieving Self-Support
|
SSA
545
BK
|
SSA
|
Form Only
|
Worker's Compensation/Public Disability Benefit Questionnaire
|
SSA
546
|
SSA
|
Form Only
|
Request for Reconsideration
|
SSA
561
U2
|
SSA
|
Form Only
|
Teacher Questionnaire
|
SSA
5665
BK
|
SSA
|
Form Only
|
Request for Administrative Information
|
SSA
5666
|
SSA
|
Form Only
|
MDCDISP/OD Modified Benefits Formula Questionnaire, Employer
|
SSA
58
|
SSA
|
Form Only
|
Authorization to Obtain Earning Data from the Social Security Administration
|
SSA
581
|
SSA
|
Form Only
|
Report of New Information in Disability Cases
|
SSA
612
|
SSA
|
Form Only
|
Representative Payee Report-This link is for informational purposes only. The SSA mails this form to registered representatives yearly and it is not available for download.
|
SSA
623
F6
|
SSA
|
Both Form and Instructions
|
Representative Payee Report-This link is for informational purposes only. The SSA mails this form to registered representatives yearly and it is not available for download.
|
SSA
6230
F6
|
SSA
|
Both Form and Instructions
|
Representative Payee Report of Benefits and Dedicated Account-This link is for informational purposes only. The SSA mails this form to registered representatives yearly and it is not available for download.
|
SSA
6233
BK
|
SSA
|
Both Form and Instructions
|
Representative Payee Evaluation Report
|
SSA
624
F5
|
SSA
|
Form Only
|
Report by Former Representative Payee
|
SSA
625
|
SSA
|
Form Only
|
Request for Waiver of Overpayment Recovery or Change in Repayment Rate
|
SSA
632
BK
|
SSA
|
Form Only
|
Expanded Monitoring Program Site Review Questionnaire For Volume Payees
|
SSA
637
|
SSA
|
Form Only
|
Site Review Questionnaire For Volume Payees
|
SSA
638
|
SSA
|
Form Only
|
Site Review Questionnaire for Fee-for-Service Payees
|
SSA
639
|
SSA
|
Form Only
|
Request for Evidence from Doctor
|
HA-
66
|
SSA
|
Form Only
|
Request for Evidence from Hospital
|
HA-
67
|
SSA
|
Form Only
|
Railroad Employment Questionnaire
|
SSA
671
|
SSA
|
Form Only
|
Application for Parent's Insurance Benefits
|
SSA
7
F6
|
SSA
|
Instructions Only
|
Request for Earnings and Benefit Estimate Statement; Request for Earnings and Benefit Statement - SP
|
SSA
7004
SM
|
SSA
|
Both Form and Instructions
|
Request for Correction of Earnings Record
|
SSA
7008
|
SSA
|
Form Only
|
Statement of Employer
|
SSA
7011
F4
|
SSA
|
Both Form and Instructions
|
Statement Regarding Date of Birth and Citizenship
|
SSA
702
|
SSA
|
Form Only
|
Request fo Social Security Earning Information
|
SSA-
7050-F4
|
SSA
|
Form Only
|
Partnership Questionnaire
|
SSA
7104
|
SSA
|
Form Only
|
Farm Self - Employment Questionnaire
|
SSA
7156
|
SSA
|
Form Only
|
Farm Arrangement Questionnaire
|
SSA
7157
F4
|
SSA
|
Form Only
|
Employment Relationship Questionnaire
|
SSA
7160
F4
|
SSA
|
Form Only
|
Report to United States Social Security Administration by Person Receiving Benefits for a Child
|
SSA
7161
OCR-SM
|
SSA
|
Form Only
|
Report to United States Social Security Administration by Person Receiving Benefits for an Adult Unable to Handle Funds
|
SSA
7162
OCR-SM
|
SSA
|
Form Only
|
Questionnaire About Employment or Self-Employment Outside the United States
|
SSA
7163
|
SSA
|
Form Only
|
Supplemental Statement Regarding Farm Activities of Persons Living Outside the U.S.A.
|
SSA
7163
A-F4
|
SSA
|
Form Only
|
Statement of Death by Funeral Director
|
SSA
721
|
SSA
|
Form Only
|
Statement Regarding the Inferred Death of an Individual by Reason of Continued & Unexplained Absence
|
SSA
723
F4
|
SSA
|
Form Only
|
Letter to Employer Requesting Information about Wages Earned
|
SSAL
725
|
SSA
|
Both Form and Instructions
|
Statement Regarding Marriage
|
SSA
753
|
SSA
|
Form Only
|
Statement of Marital Relationship
|
SSA
754
F4
|
SSA
|
Form Only
|
Certificate of Support
|
SSA
760
F4
|
SSA
|
Form Only
|
Response to Notice of Revised Determination
|
SSA
765
|
SSA
|
Form Only
|
Statement of Self-Employment Income
|
SSA
766
|
SSA
|
Form Only
|
Request For Change In Time/Place of Disability Hearing
|
SSA
769
U4
|
SSA
|
Form Only
|
Notice Regarding Substitution of Party Upon Death of Claimant Reconsideration of Disability of Cessation
|
SSA
770
U4
|
SSA
|
Form Only
|
Certificate of Responsibility for Welfare and Care of Child Not in Applicant's Custody
|
SSA
781
|
SSA
|
Form Only
|
Statement Regarding Contributions
|
SSA
783
|
SSA
|
Form Only
|
Statement of Care and Responsibility for Beneficiary
|
SSA
788
F4
|
SSA
|
Form Only
|
Request for Reconsideration - Disability Cessation
|
SSA
789
U4
|
SSA
|
Form Only
|
Statement of Claimant or Other Person
|
SSA
795
|
SSA
|
Form Only
|
Application for Lump-Sum Death Payment
|
SSA
8
F4
|
SSA
|
Instructions Only
|
Application for Supplemental Security Income
|
SSA
8000
BK
|
SSA
|
Form Only
|
Statement of Living Arrangements, In-Kind Support and Maintenance
|
SSA
8006
F4
|
SSA
|
Form Only
|
Statement of Income and Resources
|
SSA
8010
BK
|
SSA
|
Form Only
|
Statement of Household Expenses and Contributions
|
SSA
8011
F3
|
SSA
|
Form Only
|
Third-Party Liability Information Statement
|
SSA
8019
U2
|
SSA
|
Form Only
|
Agreement to Sell Property
|
SSA
8060
U3
|
SSA
|
Form Only
|
SSI Notice of Interim Assistance Reimbursement
|
SSA
8125
|
SSA
|
Both Form and Instructions
|
Reporting Events, SSI
|
SSA
8150
EV
|
SSA
|
Instructions Only
|
Work Activity Report
|
SSA
820
F4
|
SSA
|
Form Only
|
Statement for Determining Continuing Eligibility for Supplemental Security Income Payments
|
SSA
8202
BK
|
SSA
|
|
Statement for Determining Continuing Eligibility for Supplemental Security Income Payments
|
SSA
8203
BK
|
SSA
|
Both Form and Instructions
|
Work Activity Report, Employee
|
SSA
821
BK
|
SSA
|
Both Form and Instructions
|
Report on Individual with Mental Impairment
|
SSA
824
|
SSA
|
Both Form and Instructions
|
Authorization for Source to Release Information to SSA
|
SSA
827
|
SSA
|
Form Only
|
Cessation or Continuance of Disability or Blindness Determination and Transmittal
|
SSA-
832-C3/U3
|
SSA
|
Form Only
|
Supplemental Security Income, Quality Review Case Analysis
|
SSA
8508
BK
|
SSA
|
Form Only
|
State Agency Report of Obligations for SSA Disability Programs
|
SSA
871
|
SSA
|
Both Form and Instructions
|
Missing and Discrepant Wage Reports Letter and Questionnaire --- Missing and Discrepant Wage Reports Letter and Questionnaire --- Missing and Discrepant Wage Reports Letter and Questionnaire
|
SSA
95
EP
|
SSA
|
Form Only
|
Instructions for Completion of Federal Assistance Application Form SSA-96 for SSA Research and Demonstration Grant Programs
|
SSA
96
BK
|
SSA
|
Both Form and Instructions
|
Missing and Discrepant Wage Reports Letter and Questionnaire --- Missing and Discrepant Wage Reports Letter and Questionnaire --- Missing and Discrepant Wage Reports Letter and Questionnaire
|
SSA
97
EP
|
SSA
|
Both Form and Instructions
|
Quarterly Statistical Report on Recipients and Payments under State-administered Assistance Programs for Aged, Blind, and Disabled
|
SSA
9741
F3
|
SSA
|
Form Only
|
Internet Direct Deposit
|
Internet Direct Deposit
|
SSA
|
Both Form and Instructions
|
Request for Self-Employment
|
SSA
L2765
C1
|
SSA
|
Both Form and Instructions
|
Real Property Current Market Value Estimate
|
SSA
L2794
|
SSA
|
Form Only
|
Employer Verification or Records for Children under Age 7
|
SSA
L3231
C1
|
SSA
|
Both Form and Instructions
|
Request for Self-Employment
|
SSA
L3365
C1
|
SSA
|
Both Form and Instructions
|
Request for Self-Employment
|
SSA
L4002
C1
|
SSA
|
Both Form and Instructions
|
Employer Verification of Earnings After Death
|
SSA
L4112
C1
|
SSA
|
Both Form and Instructions
|
Agency/Employer Questionnaire
|
SSA
L4163
|
SSA
|
Both Form and Instructions
|
Letter to Employer Requesting Wage Information
|
SSA
L4201
F4
|
SSA
|
Form Only
|
Contact with Rep Payee, Contact with Beneficiary
|
SSA
L4945
U2
|
SSA
|
Form Only
|
Contact with Rep Payee, Contact with Beneficiary
|
SSA
L4947
U2
|
SSA
|
Form Only
|
Claimant's Statement About Loan of Food or Shelter Statement About Food or Shelter Provided to Another
|
SSA
L5063
|
SSA
|
Form Only
|
Request for Address Information from Employment Commissions
|
SSA
L711
|
SSA
|
Form Only
|
Request for Address Information from Motor Vehicle Records
|
SSA
L712
|
SSA
|
Form Only
|
Supplemental Security Income Claim Information Notice
|
SSA
L8050
U3
|
SSA
|
Both Form and Instructions
|
SSI Notice of Interim Assistance Reimbursement
|
SSA
L8125
F6
|
SSA
|
Both Form and Instructions
|
Missing and Discrepant Wage Reports Letter and Questionnaire --- Missing and Discrepant Wage Reports Letter and Questionnaire --- Missing and Discrepant Wage Reports Letter and Questionnaire
|
SSA
L93
SM
|
SSA
|
Both Form and Instructions
|
Mid-Year Mailer
|
SSA
L9778
SM-SUP
|
SSA
|
Both Form and Instructions
|
Mid-Year Mailer
|
SSA
L9779
SM-SUP
|
SSA
|
Both Form and Instructions
|
Mid-Year Mailer
|
SSA
L9781
SM
|
SSA
|
Both Form and Instructions
|
EVS Registration Form
|
N/A
|
SSA
|
Form Only
|
Internet Application Status
|
N/A
|
SSA
|
Both Form and Instructions
|
Certificate of Coverage Request
|
SSA
i0554
|
SSA
|
Both Form and Instructions
|
Request for Replacement SSA-1099/SSA-1042S Social Security Benefits Statement
|
SSA
i0583
0
|
SSA
|
Both Form and Instructions
|
Electronic Benefit Verification Information
|
SSA
i0595
|
SSA
|
Both Form and Instructions
|
Internet Social Security Benefit Application (ISBA)
|
SSA
i0618
|
SSA
|
Both Form and Instructions
|
Internet Social Security Disability Report (ISSDR)
|
SSA
i0650
|
SSA
|
Both Form and Instructions
|
Internet Social Security Disability Report - Child
|
SSA
i3820
|
SSA
|
Both Form and Instructions
|