Forms List

193 results for: Social Security Administration.
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