Documents
Form SSA-44 Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event
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-10 Application for Widow's or Widower's Insurance Benefits
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-521 Request for Withdrawal of Application
Use this form to cancel the application for Social Security benefits you submitted.
Form SSA-795 Statement of Claimant or Other Person
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
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
Download this form if you are an employer and need to report the special wages you pay to an employee.
Form SSA-3288 Consent for Release of Information
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-1945 Statement Concerning Your Employment in a Job Not Covered by Social Security
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-11-BK Request to Be Selected as Payee
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
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-1372-BK Advance Notice of Termination of Child's Benefits
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
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
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
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-3373-BK Function Report - Adult
This form was used to determine if an individual was eligible for Social Security disability benefits.
Form SSA-10-INST Reporting Responsiblities for Widow's or Widower's Insurance Benefits
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-3288-SP Consentimiento Para Divulgar Informacion
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-1372-BK-FC Advance Notice of Termination of Child's Benefits
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-16 Application for Disability Insurance Benefits
Form 21 Supplement to Claim of Person Outside the United States
Form SSA-308 Modified Benefit Formula Questionnaire - Foreign Pension
Form SSA-7-F6 Application for Parent's Insurance Benefits
Form SSA-1425 Reporting Changes That Affect Your Social Security Payment
Instructions for Form SSA-1021 Appeal of Determination for Extra Help With Medicare Prescription Drug Plan Costs
Form SSA-89-sp Autorizacion Para Que La Administracion De Seguro Social Divulgue La Verificacion De Un Numero De Seguro Social (Ssn)
Form SSA-3881-bk Questionnaire for Children Claiming Ssi Benefits
Form SSA-1383-FC Report to Social Security Administration by Student Outside the United States
Form SSA-4734-BK Physical Residual Functional Capacity Assessment
Form SSA-4734-F4-SUP Mental Residual Functional Capacity Assessment
