Social Security Forms and Templates

41
total templates

Documents

41

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

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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.

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U.S. Social Security Administration

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

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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).

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U.S. Social Security Administration

Form SSA-521 Request for Withdrawal of Application

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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.

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U.S. Social Security Administration

Form SSA-795 Statement of Claimant or Other Person

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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).

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U.S. Social Security Administration Legal

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

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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.

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U.S. Social Security Administration

Form SSA-131 Employer Report of Special Wage Payments

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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.

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U.S. Social Security Administration

Form SSA-3288 Consent for Release of Information

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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.

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U.S. Social Security Administration

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

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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.

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U.S. Social Security Administration

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

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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.

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U.S. Social Security Administration Legal

Form SSA-821-BK Work Activity Report - Employee

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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.

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U.S. Social Security Administration

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

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

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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.

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U.S. Social Security Administration

Form SSA-3368-BK Disability Report - Adult

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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.

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U.S. Social Security Administration

Form SSA-3369-BK Work History Report

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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.

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U.S. Social Security Administration

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.

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U.S. Social Security Administration

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

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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.

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U.S. Social Security Administration

Form SSA-3288-SP Consentimiento Para Divulgar Informacion

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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.

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U.S. Social Security Administration

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-821-bk Work Activity Report - Employee

Rate
4.8(4.8 / 5) 53 votes
Size: 433 KB
12 pages
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U.S. Social Security Administration Legal