Social Security Forms and Templates

41
total templates

Documents

41

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

Rate (4.8 / 5) 31 votes
Size: 369 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-44 "Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event"

Rate (4.7 / 5) 119 votes
Size: 127 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-16 "Application for Disability Insurance Benefits"

Rate (4.5 / 5) 95 votes
Size: 193 KB
7 pages

This document is used to apply for Social Security Disability Benefits with the SSA.

Form SSA-521 "Request for Withdrawal of Application"

Rate (4.7 / 5) 37 votes
Size: 71 KB
2 pages

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

Form SSA-795 "Statement of Claimant or Other Person"

Rate (4.8 / 5) 106 votes
Size: 47 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 (Ssa)"

Rate (4.5 / 5) 80 votes
Size: 60 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 / 5) 59 votes
Size: 318 KB
2 pages

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

Form SSA-7-F6 "Application for Parent's Insurance Benefits"

Rate (4.3 / 5) 22 votes
Size: 344 KB
6 pages

This application is filed by dependent parents of deceased workers with enough Social Security credits to confirm eligibility for SSA benefits.

Form SSA-3288 "Consent for Release of Information"

Rate (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-1945 "Statement Concerning Your Employment in a Job Not Covered by Social Security"

Rate (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-11-BK "Request to Be Selected as Payee"

Rate (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 (4.6 / 5) 99 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-1372-BK "Advance Notice of Termination of Child's Benefits"

Rate (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 / 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 / 5) 53 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 / 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 / 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.

Formulario SSA-3288-SP "Consentimiento Para Divulgar Informacion" (Spanish)

Rate (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 / 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 / 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 SS-5 "Application for a Social Security Card"

Rate (4.5 / 5) 96 votes
Size: 135 KB
5 pages

This is a legal document filled out to apply for a new or replacement Social Security card.

Form 21 "Supplement to Claim of Person Outside the United States"

Rate (4.7 / 5) 71 votes
Size: 118 KB
5 pages

Form SSA-308 "Modified Benefit Formula Questionnaire - Foreign Pension"

Rate (4.6 / 5) 74 votes
Size: 64 KB
3 pages

Form MC194 "Social Security Administration Referral Notice" - California

Rate (4.5 / 5) 103 votes
Size: 371 KB
2 pages

Form SSA-1383 "Student Reporting Form"

Rate (4.5 / 5) 59 votes
Size: 79 KB
3 pages

Form SSA-5666 "Request for Administrative Information"

Rate (4.5 / 5) 62 votes
Size: 227 KB
2 pages

Form SSA-3105 "Request Waiver or Reconsideration"

Rate (4.4 / 5) 52 votes
Size: 60 KB
2 pages

Form SSA-1425 "Reporting Changes That Affect Your Social Security Payment"

Rate (4.3 / 5) 41 votes
Size: 139 KB
4 pages

Instructions for Form SSA-1021 "Appeal of Determination for Extra Help With Medicare Prescription Drug Plan Costs"

Rate (4.8 / 5) 8 votes
Size: 412 KB
2 pages

Formulario SSA-89-sp "Autorizacion Para Que La Administracion De Seguro Social Divulgue La Verificacion De Un Numero De Seguro Social (Ssn)" (Spanish)

Rate (4.4 / 5) 46 votes
Size: 53 KB
2 pages

Form SSA-B20-BK "Work Activity Report - Self-employment"

Rate (4.5 / 5) 53 votes
Size: 351 KB
8 pages

Form SSA-5665-bk "Teacher Questionnaire"

Rate (4.6 / 5) 69 votes
Size: 1 MB
10 pages

Form SSA-3881-bk "Questionnaire for Children Claiming Ssi Benefits"

Rate (4.4 / 5) 57 votes
Size: 123 KB
8 pages

Form SSA-1383-FC "Report to Social Security Administration by Student Outside the United States"

Rate (4.7 / 5) 66 votes
Size: 79 KB
2 pages

Form SSA-4734-BK "Physical Residual Functional Capacity Assessment"

Rate (4.3 / 5) 67 votes
Size: 277 KB
7 pages

Form SSA-1199-GE "Direct Deposit Sign-Up Form (Germany)"

Rate (4.5 / 5) 160 votes
Size: 68 KB
3 pages

Form 1199-FR "Direct Deposit Sign-Up Form (France)"

Rate (4.5 / 5) 47 votes
Size: 2 MB
2 pages

Form SSA-4734-F4-SUP "Mental Residual Functional Capacity Assessment"

Rate (4.6 / 5) 75 votes
Size: 126 KB
4 pages

"Social Security Benefits Payments Schedule", 2018

Rate (4.8 / 5) 14 votes
Size: 123 KB
1 page