SS-5 |
Application for a Social Security Card
|
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-85 |
Request to Withdraw a Hearing Request |
HA-86 |
Discontinue Prior Editions |
HA-86-SP |
SOLICITUD PARA RETIRAR UNA PETICIÓN PARA REVISIÓN CON EL CONSEJO DE APELACIONES |
HA-501-U5 |
Request for Hearing by Administrative Law Judge |
HA-510 |
Waiver of Timely Written Notice of Hearing |
HA-510-SP |
Renuncia a la notificación escrita oportuna de la audiencia |
HA-520 |
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-3-SP |
CERTIFICACION DE MATRIMONIO |
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 |
SS-5-AR-INST |
Instructional Guide for Completing the Application for a Social Security Card - Arabic |
SS-5-AM-INST |
Instructional Guide for Completing the Application for a Social Security Card - Armenian |
SS-5-CH-INST |
Instructional Guide for Completing the Application for a Social Security Card - Chinese Traditional |
SS-5-CHS-INST |
Instructional Guide for Completing the Application for a Social Security Card - Chinese Simplified |
SS-5-FA-INST |
Instructional Guide for Completing the Application for a Social Security Card - Farsi |
SS-5-FR-INST |
Instructional Guide for Completing the Application for a Social Security Card - French |
SS-5-GR-INST |
Instructional Guide for Completing the Application for a Social Security Card - Greek |
SS-5-HC-INST |
Instructional Guide for Completing the Application for a Social Security Card - Haitian Creole |
SS-5-IT-INST |
Instructional Guide for Completing the Application for a Social Security Card - Italian |
SS-5-KOR-INST |
Instructional Guide for Completing the Application for a Social Security Card - Korean |
SS-5-PE-INST |
Instructional Guide for Completing the Application for a Social Security Card - Portuguese |
SS-5-PO-INST |
Instructional Guide for Completing the Application for a Social Security Card - Polish |
SS-5-RU-INST |
Instructional Guide for Completing the Application for a Social Security Card - Russian |
SS-5-SO-INST |
Instructional Guide for Completing the Instructional Guide for Completing the Application for a Social Security Card - Somali |
SS-5-TL-INST |
Instructional Guide for Completing the Application for a Social Security Card - Taglog |
SS-5-UA-INST |
Instructional Guide for Completing the Application for a Social Security Card - Ukraine |
SS-5-VI-INST |
Instructional Guide for Completing the Application for a Social Security Card - Vietnamese |
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-10-SP |
Solicitud Para Beneficios de Seguro como Cónyuge Sobreviviente |
SSA-16 |
Application for Disability Insurance Benefits |
SSA-16-SP |
Solicitud para beneficios de seguro por incapacidad |
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-186 |
Temporary Institutionalization Statement to Maintain Household and Physician Certification |
SSA-199 |
Vocational Rehabilitation Provider Claim |
SSA-263 |
Waiver of Supplemental Security Income Payment Continuation |
SSA-268 |
Patient Acknowledgement Form for Influenza Vaccination |
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-632-BK-SP |
Solicitud de exoneración de sobrepago |
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-731 |
Notice to Electronic Information Exchange Partners to Provide Contractor List |
SSA-753 |
Statement Regarding Marriage |
SSA-760 |
Certificate of Support |
SSA-765 |
Response to Notice of Revised Determination |
SSA-766 |
Statement of Self-Employment Income |
SSA-754-F5 |
Statement of Marital Relationship |
SSA-769 |
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 |
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 |
Request for Reconsideration - Disability Cessation |
SSA-795 |
Statement of Claimant or Other Persons |
SSA-795-SP |
Statement of Claimant or Other Persons (Spanish) |
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 |
SSA-1020 Forms |
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-1391 |
Employment Network Payment Request Form |
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-1691 |
Eligible Non-Attorney Representative Application |
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 |
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-2490 |
Application For Benefits Under a U.S. International Social Security Agreement |
SSA-2512 |
Pre-1957 Military Service Federal Benefit Questionnaire |
SSA-2519 |
Child Relationship Statement |
SSA-2574 |
Information About Joint Checking/Savings Accounts Supplemental Security Income |
SSA-2855 |
Statement of Funds you Received |
SSA-2935 |
Authorization to the Social Security Administration to Obtain Personal Information |
SSA-3033 |
Employee Work Activity Questionnaire |
SSA-3105 |
Important information about your appeal, waiver rights, and repayment options |
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-3830 |
Certification of Low Birth Weight for SSI Eligibility |
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-4178 |
Marital Relationship Questionaire |
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-5064 |
Claimant's Statement About Loan For Shelter |
SSA-5665-BK |
Teacher Questionnaire |
SSA-5665-BK-SP |
Cuestionario para Maestros (Teacher Questionnaire) |
SSA-5666 |
Request for Administrative Information |
SSA-7004 |
Request for Social Security Statement |
SSA-7004-SP |
Solicitud para un Estado de cuenta del Seguro Social |
SSA-7008 |
Request for Correction of Earnings Record |
SSA-7011-F4 |
Statement of Employer |
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 |
Supplemental Statement Regarding Farming Activities |
SSA-8000-BK |
Application for Supplemental Security Income (SSI) |
SSA-8001-BK |
Application for Supplemental Security Income (SSI) (Deferred or Abbreviated) |
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-8552 |
Interview Confirmation |