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Social Security Forms

The following social security forms are provided by the Social Security Administration and are commonly required by claimants seeking Social Security Benefits.

These forms are in Portable Document Format(PDF). PDF files are printer independent using any printer. To read and print a PDF publication, you must have the Adobe Acrobat Reader software installed on your PC.

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Claims Support Forms:

SSA-3 Marriage Certification

SSA-21 Supplement to Claim of Person Outside the United States

SSA-150 Modified Benefits Formula Questionnaire

SSA-308 Modified Benefits Formula Questionnaire, Foreign Pension

SSA-521 Request for Withdrawal of Application

SSA-546 Worker’s Compensation/Public Disability Questionnaire

SSA-671 Railroad Employment Questionnaire

SSA-723 Statement Regarding the Inferred Death of an Individual

SSA-781 Certificate of Responsibility for Welfare and Care of Child

SSA-782 Reconsideration Report for Disability Cessation

SSA-783 Statement Regarding Contributions

SSA-788 Statement of Care and Responsibility for Beneficiary

SSA-795 Statement of Claimant or Other Persons

SSA-820-F4 Work Activity Report (Self-Employed Person)

SSA-821-BK Work Activity Report

Authorization to Disclose Information to the Social Security Administration (SSA-827)

SSA-1372-BK Student’s Statement Regarding School Attendance

SSA-2512 Pre-1957 Military Service Federal Benefit Questionnaire

SSA-2519 Child Relationship Questionnaire

SSA-3368 Disability Report, Adult

SSA-3369 Work history Report

SSA-3820 Disability Report, Child

SSA-3885 Government Pension Questionnaire

SSA-4162 Child Care Dropout Questionnaire

SSA-5665-BK Teacher Questionnaire

SSA-5666 Request for Administrative Information

SSA-4184 Self Employment Corporate Officer Questionnaire

SSA-7008 Request for Correction of Earnings Record

SSA-7104 Partnership Questionnaire

SSA-7156 Farm Self Employment Questionnaire

SSA-7157 Farm Arrangement Questionnaire

SSA-7163 Questionnaire About Employment or Self Employment

SSA-7163A Supplemental Statement Regarding Farming Activities

Other Forms:

Application for a Social Security Card (SS-5)
Application for a Social Security Card – Foreign Service (SS-5-FS)
Application for Special Benefits for World War II Veterans (SSA-2000)
Appointment of Representative (SSA-1696)
Claim For Amounts Due In Case Of A Deceased Beneficiary (SSA-1724)
Claimant’s Medications (HA-4632)
Claimant’s Recent Medical Treatment (HA-4631)
Claimant’s Statement when Request for hearing is Filed and the Issue is Disability (HA-4486)
Claimant’s Work Background (HA-4633)
Consent for Release of Information (SSA-3288)
Discrimination Complaint (SSA-437-BK) – A form to be used to file a Civil Rights complaint with the Office of the General Counsel for Social Security
Employer Report of Special Wage Payments (SSA-131)
Notice Regarding Substitution of Party Upon Death of Claimant (HA-539)
Petition to Obtain Approval of a Fee For Representing …(SSA-1560)
Plan for Achieving Self-Support (SSA-545)
Reconsideration Disability Report (SSA-3441-F6)
Request for Social Security Earnings Information (SSA-7050)
Request for hearing by Administrative Law Judge (HA-501-U5)
Request for Reconsideration (SSA-561-U2)
Request for Review of Decision/Order of Administrative Law Judge (HA-520)
Request for Waiver of Overpayment Recovery or Change in Repayment Rate (SSA-632-BK)
Request for Social Security Statement (AKA Earnings and Benefit Estimate Statement) (SSA-7004)
Solicitud de Declaracion de Ganancias y Calculo de Beneficios (SSA-7004-SP)
Solicitud Para una Tarjeta de Seguro Social (SS-5-SP)
Waiver of Your Right to Personal Appearance Before an Administrative Law Judge (HA-4608)
Waiver of Written Notice of hearing, (HA-510)

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