U.S. Social Security Administration Forms

90
total templates

Documents

90

Form SSA-44 Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event

Rate
4.5(4.5 / 5) 36 votes
Size: 130 KB
8 pages

Use this form in cases when you need to notify the Social Security Administration (SSA) about a change in income, as well as to request a reduction of the income-related monthly adjustment amount (IRMAA) of the Medicare premium based of a life-changing event.

Form SSA-89 Authorization for the Social Security Administration (Ssa) to Release Social Security Number (Ssn) Verification

Rate
4.6(4.6 / 5) 68 votes
Size: 52 KB
2 pages

The procuring data from this form is used by the Social Security Administration (SSA) to allow a third party to establish a link between a person's name and a social security number. This requirement is mandatory.

Form SSA-10 Application for Widow's or Widower's Insurance Benefits

Rate
4.8(4.8 / 5) 31 votes
Size: 353 KB
8 pages

Use this form if you are the surviving spouse of a 100% insured wage earner and wish to claim the insurance benefits owed to your deceased spouse by the Social Security Administration (SSA).

Form SSA-789 Request for Reconsideration - Disability Cessation Right to Appeal

Rate
4.5(4.5 / 5) 32 votes
Size: 65 KB
2 pages

File this form to request a reconsideration for a cessation of disability benefits.

Form SSA-521 Request for Withdrawal of Application

Rate
4.8(4.8 / 5) 36 votes
Size: 71 KB
2 pages

Use this form to cancel the application for Social Security benefits you submitted.

Form SSA-787 Physician's/Medical Officer's Statement of Patient's Capability to Manage Benefits

Rate
4.3(4.3 / 5) 74 votes
Size: 51 KB
3 pages

Download this form to determine if a person is capable to manage their funds or if they need a representative payee. This form contains information about a person who receives Social Security benefits or Supplemental Security Income (SSI) payments.

Form SSA-795 Statement of Claimant or Other Person

Rate
4.8(4.8 / 5) 84 votes
Size: 178 KB
2 pages

Use this form to supply the Social Security Administration (SSA) with a signed statement when applying for Social Security benefits or Supplemental Security Income (SSI).

Form SSA-827 Authorization to Disclose Information to the Social Security Administration

Rate
4.5(4.5 / 5) 61 votes
Size: 312 KB
2 pages

Use this form to supply the Social Security Administration (SSA) with written consent to release your personal information from medical, educational, and other required sources.

Form SSA-131 Employer Report of Special Wage Payments

Rate
4.8(4.8 / 5) 42 votes
Size: 1 MB
2 pages

Download this form if you are an employer and need to report the special wages you pay to an employee.

Form SSA-1099 2018 Social Security Benefit Statement

Rate
4.5(4.5 / 5) 45 votes
Size: 2 MB
1 page

Use this form annually to report social security benefits that you received last year. You can use this form for tax purposes by indicating your social security income to the Internal Revenue Service (IRS) on your tax return.

Form SSA-3288 Consent for Release of Information

Rate
4.4(4.4 / 5) 90 votes
Size: 1 MB
2 pages

With the help of this form, you can provide the Social Security Administration (SSA) with a written authorization to release your personal information to a third-party.

Form SSA-7004 Request for Social Security Statement

Rate
4.7(4.7 / 5) 71 votes
Size: 1 MB
3 pages

The Social Security Administration (SSA) uses this form to request information about the individual's earning history, in order to estimate their eligibility for Social Security benefits and taxes paid in Social Security.

Form SSA-1945 Statement Concerning Your Employment in a Job Not Covered by Social Security

Rate
4.7(4.7 / 5) 60 votes
Size: 173 KB
2 pages

Use this form if you have a job and do not pay Social Security tax, in order to provide an explanation as to how your present job can affect your Social Security benefits.

Form SSA-7028 Notice to Third Party of Social Security Number Assignments

Rate
4.5(4.5 / 5) 60 votes
Size: 95 KB
1 page

Use this form to authorize the Social Security Administration (SSA) to release your information to a third party for the purpose of preparing a wage or tax report or completing your record, including your Social Security Number (SSN).

Form SSA-11-BK Request to Be Selected as Payee

Rate
4.8(4.8 / 5) 63 votes
Size: 74 KB
10 pages

Use this form if you wish to apply to be a representative payee. This is a relative or a friend who manages the benefits of a disabled person when they are unable to do so themselves or have difficulties in managing their money due to their condition.

Form SSA-821-BK Work Activity Report - Employee

Rate
4.3(4.3 / 5) 46 votes
Size: 243 KB
12 pages

Use this form to report an individual's working activity after the alleged onset date (AOD) to the Social Security Administration (SSA) in order to qualify for disability benefits.

Form SSA-632-BK Request for Waiver of Overpayment Recovery or Change in Repayment Rate

Rate
4.3(4.3 / 5) 49 votes
Size: 244 KB
9 pages

Use this form if you are the subject of overpayments and wish to have Social Security Administration (SSA) reconsider their decision about repayments.

Form SSA-561-U2 Request for Reconsideration

Rate
4.6(4.6 / 5) 65 votes
Size: 106 KB
4 pages

Download this form if you wish to make an online appeal of a Social Security Administration (SSA) decision regarding your benefit request.

Form SSA-623-F6 Representative Payee Report

Rate
4.8(4.8 / 5) 64 votes
Size: 398 KB
6 pages

Download this form if you a representative payee and wish to report how you use the benefits you receive on behalf of a Social Security or Supplemental Security Income (SSI) beneficiary.

Form SSA-7050-F4 Request for Social Security Earnings Information

Rate
4.4(4.4 / 5) 40 votes
Size: 94 KB
4 pages

Use this form to request detailed information about your earnings that affect your Social Security benefits and retirement amount.

Form SSA-1695-F3 Identifying Information for Possible Direct Payment of Authorized Fees

Rate
4.5(4.5 / 5) 49 votes
Size: 63 KB
3 pages

Use this form to provide the Social Security Administration (SSA) with information for direct payments of an authorized fee.

Form SSA-3441-BK Disability Report - Appeal

Rate
4.8(4.8 / 5) 95 votes
Size: 213 KB
10 pages

Use this form to contest a decision regarding disability benefits by providing new information on your or the claimant's impairment.

Form SSA-1696-U4 Appointment of Representative

Rate
4.6(4.6 / 5) 55 votes
Size: 197 KB
9 pages

Use this form while dealing with the Social Security Administration (SSA) to appoint a third-party representative to act on your behalf.

Form SSA-1372-BK Advance Notice of Termination of Child's Benefits

Rate
4.3(4.3 / 5) 83 votes
Size: 153 KB
8 pages

Use this form after you received a notice of Termination of Benefits from the Social Security Administration (SSA) for verifying your child's full-time attendance (FTA) at an educational institution and continuation of the FTA.

Form SSA-10-INST Reporting Responsiblities for Widow's or Widower's Insurance Benefits

Rate
4.5(4.5 / 5) 6 votes
Size: 61 KB
2 pages

This form is used by the Social Security Administration (SSA) to inform the recipient of widow's or widower's insurance benefits about what changes to report to the SSA and how. The document lists changes to be reported and the means to report them.

Form SSA-1724-F4 Claim for Amounts Due in the Case of a Deceased Beneficiary

Rate
4.7(4.7 / 5) 52 votes
Size: 1 MB
3 pages

Use this form to claim for Social Security benefits or Medicare Premium refund that a deceased beneficiary may have been due prior to passing away.

Form SSA-3368-BK Disability Report - Adult

Rate
4.5(4.5 / 5) 47 votes
Size: 352 KB
14 pages

Use this form if you are an adult and are claiming disability benefits. You can fill out the form yourself or have a representative help you out. It can be any person who is aware of your health issues, but it cannot be your doctor.

Form SSA-3369-BK Work History Report

Rate
4.6(4.6 / 5) 71 votes
Size: 1 MB
10 pages

Use this form to supply the Social Security Administration (SSA) with detailed information about the jobs you have had in the past 15 years.

Form SSA-3288-SP Consentimiento Para Divulgar Informacion

Rate
4.5(4.5 / 5) 57 votes
Size: 132 KB
4 pages

Spanish-speaking applicants may use this form to give the Social Security Administration (SSA) permission to release the information from personal SSA files to a specific individual or group.

Form SSA-3373-BK Function Report - Adult

Rate
4.3(4.3 / 5) 105 votes
Size: 194 KB
10 pages

This form was used to determine if an individual was eligible for Social Security disability benefits.

Form SSA-1372-BK-FC Advance Notice of Termination of Child's Benefits

Rate
4.8(4.8 / 5) 89 votes
Size: 149 KB
8 pages

Use this form if you are an insured worker and received a notice of Termination of Benefits from the Social Security Administration (SSA). Fill out this form if you are eligible to continue to receive the benefits after your child turns 18.

Form SSA-455-OCR-SM Disability Update Report

Rate
4.4(4.4 / 5) 50 votes
Size: 226 KB
6 pages

This form is mailed to a disabled beneficiary or their representative by the Social Security Administration (SSA) to update their information including information about the treatment they received in the past two years.

Form SSA-6230-OCR-SM Representative Payee Report

Rate
4.6(4.6 / 5) 80 votes
Size: 152 KB
6 pages

You can use this form to assist the Social Security Administration (SSA) beneficiaries by managing their social security and/or supplemental security income payments.