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All forms are FREE. Timing 1 7 5. Not all forms are listed. If you can't find the form you need, or you need help completing a form, please call us at 1-800-772-1213 (TTY 1-800-325-0778) High limit slots strategy. or contact your local Social Security office and we will help you. If you download, print and complete a paper form, please mail or take it to your local Social Security office or the office that requested it from you.
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The form you are looking for is not available online. Many forms must be completed only by a Social Security Representative. Please call us at 1-800-772-1213 (TTY 1-800-325-0778) Monday through Friday between 8 a.m. and 5:30 p.m. or contact your local Social Security office.Web Confidential 5 0 44 +
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| Number | Title |
|---|---|
| SS-5 | Application for a Social Security Card In some areas, you may request a replacement Social Security card online. |
| SSA-827 | Authorization to Disclose Information to the Social Security Administration |
| 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-454-BK | Continuing Disability Review Report |
| 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-1696 | Claimant's Appointment of Representative |
| 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-7004 | Request for Social Security Statement |
| 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 |
