Download Form SSA-3288-SP Consentimiento Para Divulgar Informacion
SSA Form 3288-SP Instructions
Complete Form SSA-3288 when you need to release your Social Security records to an individual or company (e.g. medical institution or insurance company). You cannot use this form to request your employment history or earnings information - fill out Form SSA-7050-F4 (in English) instead.
You also can submit this form on behalf of a minor or legally incompetent adult. If you are a parent or legal guardian of a minor child, fill out this document to release non-medical information only. Visit your local Social Security office or call the toll-free number provided on the form to release medical records of a minor child.
Form SSA-3288 instructions are provided on the first two pages of the form. Moreover, you can find detailed step-by-step completion instructions below. Fill out all fields marked with an asterisk (*), otherwise, the SSA will not be able to process your request.
The instructions for the SSA information release form are as follows:
- Enter your or the person to whom the information pertains full name, date of birth, and Social Security number (SSN) in the appropriate fields on the top of the form;
- Provide the name and full mailing address of an individual or a company the SSA should deliver your information to;
- Specify the exact reason why you need to release information to this individual or company; the SSA may charge you a fee for providing information unrelated to the administration of the Social Security program;
- Choose the type of information you want to release by checking the appropriate boxes and specifying the date ranges where applicable;
- Sign the form, date it, and provide your phone number;
- The address field is optional;
- If you request the release on the behalf of a minor or incompetent person, specify your relationship and be ready to provide proof if requested;
- If you sign with "X", provide the signatures and addresses of two witnesses who know you.
Where to Send Form SSA-3288-SP?
Mail or bring the completed form to your local Social Security office. You can find the address you need on the SSA website or request it by calling the toll-free number indicated on the second page of the form.
SSA 3288-SP Related Publications
The form has the following related publications:
- Form SSA-827, Authorization to Disclose Information to the Social Security Administration is the form you fill out to allow the SSA to obtain your health information from the institution you were treated in;
- Form SSA-89, Authorization for the Social Security Administration to Release Social Security Number (SSN) Verification is a form you submit to authorize the SSA to verify your name and SSN to a specific company or an agent designated by this company;