DISCLAIMER - THIS WEBSITE IS NOT ENDORSED BY OR AFFILIATED WITH THE U.S. SOCIAL SECURITY ADMINISTRATION , OR ANY GOVERNMENTAL ENTITY.
Carol Thomas has recently retired from the Social Security Administration after 28 years service. If you have any questions about Social Security, please ask. We will use the questions you send for future posts. I will never post anyone's name, or other identifiable information.
AGENCY |
FORM # |
FORM NAME |
TYPE |
REVISED |
SSA
|
SSA
0000
|
Social Security Address Change Instructions
|
Both Form and Instructions
|
|
SSA
|
SSA
1
|
Application for Retirement Insurance Benefits
|
Both Form and Instructions
|
Mar 01, 2006
|
SSA
|
SSA
10
BK
|
Application for Widow's or Widower's Insurance Benefits
|
Instructions Only
|
Jan 01, 2006
|
SSA
|
SSA
1002
F3
|
Statement of Agricultural Employer (Years Prior to 1988)
|
Both Form and Instructions
|
Jul 01, 1992
|
SSA
|
SSA
1003
F3
|
Statement of Agricultural Employer (1988 and Later)
|
Both Form and Instructions
|
Jul 01, 1992
|
SSA
|
SSA
11
BK
|
Request To Be Selected As Payee
|
Both Form and Instructions
|
Mar 01, 2006
|
SSA
|
SSA
1272
U4
|
Subpoena, Disability Hearing
|
Form Only
|
Apr 01, 1984
|
SSA
|
SSA
1294
F6-CN
|
Application for U.S. Benefits under the Canada-U.S. International Agreement
|
Both Form and Instructions
|
Apr 01, 1996
|
SSA
|
SSA
131
|
Employer Report of Special Wage Payments
|
Both Form and Instructions
|
Aug 01, 2001
|
SSA
|
SSA
1344
|
Chinese Custom Marriage Statement --- Statement Regarding Chinese Custom Marriage
|
Form Only
|
Feb 01, 1983
|
SSA
|
SSA
1345
|
Chinese Custom Marriage Statement --- Statement Regarding Chinese Custom Marriage
|
Form Only
|
Apr 01, 1979
|
SSA
|
SSA
1365
|
State Agency Ticket Assignment Form
|
Both Form and Instructions
|
Oct 01, 2001
|
SSA
|
SSA
1366
F3
|
State Vocational Information Sheet
|
Form Only
|
Mar 01, 2002
|
SSA
|
SSA
1367
F3
|
Individual Work Plans (IWP)
|
Form Only
|
Mar 01, 2002
|
SSA
|
SSA
1371
FC
|
Statement to U.S. Social Security Administration by School Outside the U.S. About Student's Attendance
|
Form Only
|
Aug 01, 1990
|
SSA
|
SSA
1371
|
Statement to U.S. Social Security Administration by School Outside the U.S. About Student's Attendance
|
Form Only
|
Jul 01, 1992
|
SSA
|
SSA
1372
BK
|
Advance Notice of Termination of a Child's Benefits & Student's Statement Regarding School Attendance
|
Form Only
|
Aug 01, 2006
|
SSA
|
SSA
1383
|
Student Reporting Form
|
Form Only
|
Jul 01, 2005
|
SSA
|
SSA
1414
|
Credit Card payment Form
|
Form Only
|
Feb 01, 2002
|
SSA
|
SSA
1425
|
Reporting Changes that Affect Your Social Security Payment
|
Form Only
|
Feb 01, 2002
|
SSA
|
SSA
1458
|
Certification by a Religious Group
|
Form Only
|
Nov 01, 1991
|
SSA
|
SSA
150
|
Benefits Formula Questionnaire
|
Form Only
|
Jul 01, 2003
|
SSA
|
SSA
1535
U3
|
Application for Search of Census Record for Proof of Age
|
Form Only
|
Jul 01, 2006
|
SSA
|
SSA
1560
U4
|
Petition to Obtain Approval of a Fee for Representing a Claimant before the Social Security Administration
|
Both Form and Instructions
|
Feb 01, 2005
|
SSA
|
SSA
1587
OCR-SM
|
Beneficiary Recontact Report
|
Both Form and Instructions
|
Oct 01, 1997
|
SSA
|
SSA
1588
OCR-SM
|
Beneficiary Recontact Report
|
Form Only
|
Apr 01, 1997
|
SSA
|
SSA
16
BK
|
Application for Disability Insurance Benefits
|
Both Form and Instructions
|
May 01, 2006
|
SSA
|
SSA
1696
U4
|
Appointment of Representative
|
Both Form and Instructions
|
Jan 01, 2005
|
SSA
|
SSA
1724
|
Claim for Amounts Due in Case of a Deceased Beneficiary
|
Form Only
|
Nov 01, 1984
|
SSA
|
SSA
19
F6
|
Application for Special Age 72-Or-Over Monthly Payments
|
Form Only
|
Jul 01, 1989
|
SSA
|
SSA
199
|
Vocational Rehabilitation Provider Claim -- 20 CFR Subpart V Subpart V
|
Form Only
|
Feb 01, 2002
|
SSA
|
SSA
2
BK
|
Application for Wife's or Husband's Insurance
|
Both Form and Instructions
|
Apr 01, 2006
|
SSA
|
SSA
2000
F6
|
Application for Special Benefits for World War II Veterans
|
Form Only
|
Oct 01, 2006
|
SSA
|
SSA
2001
|
Representative Payee Report -- Special Veterans
|
Both Form and Instructions
|
Jul 01, 2000
|
SSA
|
SSA
21
|
Supplement to Claim of Person Outside the United States
|
Form Only
|
Mar 01, 2006
|
SSA
|
SSA
24
|
Application for Survivor's Benefits
|
Form Only
|
Feb 01, 2002
|
SSA
|
SSA
2434
F3
|
Statement Regarding Student's Attendance
|
Form Only
|
Oct 01, 1983
|
SSA
|
SSA
2490
BK
|
Application for Benefits Under a U.S. International Social
|
Form Only
|
Apr 01, 2004
|
SSA
|
SSA
25
|
Certificate of Election for Reduced Spouse's Benefits
|
Form Only
|
Feb 01, 2006
|
SSA
|
SSA-
2506
-BK
|
Psychiatric Review Technique
|
Form Only
|
|
SSA
|
SSA
2512
|
Pre-1957 Military Service Federal Benefit Questionnaire
|
Form Only
|
Apr 01, 1984
|
SSA
|
SSA
2519
|
Child Relationship Statement
|
Form Only
|
Apr 01, 2002
|
SSA
|
SSA
2528
F4-IT
|
Application for Benefits, Italy-U.S.A. Agreement on Social Security
|
Both Form and Instructions
|
Dec 01, 2000
|
SSA
|
SSA
2574
|
Information About Joint Checking/Savings Account
|
Form Only
|
Feb 01, 1998
|
SSA
|
SSA
2854
|
Statement of Funds You Provided to Another Statement of Funds You Received
|
Form Only
|
Dec 01, 2000
|
SSA
|
SSA
2855
|
Statement of Funds You Provided to Another Statement of Funds You Received
|
Form Only
|
Feb 01, 1990
|
SSA
|
SSA
293
|
Inquiry to File an SSI Child's Application
|
Form Only
|
Feb 01, 1999
|
SSA
|
SSA
2930
BK
|
RSI/DI Quality Review Case Analysis - Sampled Number Holder
|
Form Only
|
Jul 01, 2000
|
SSA
|
SSA
2931
BK
|
RSI/DI Quality Review Case Analysis - Sampled Number Holder
|
Form Only
|
Jul 01, 2000
|
SSA
|
SSA
2932
BK
|
RSI/DI Quality Review Case Analysis - Sampled Number Holder
|
Form Only
|
Nov 01, 1992
|
SSA
|
SSA
3
|
Marriage Certification
|
Form Only
|
Apr 01, 2003
|
SSA
|
SSA
3033
|
Employee Work Activity Report
|
Form Only
|
Sep 01, 1989
|
SSA
|
SSA
308
|
Modified Benefit Formula Questionnaire, Foreign Pension
|
Form Only
|
Dec 01, 1996
|
SSA
|
SSA
3192
F4
|
Medical Parking Application
|
Both Form and Instructions
|
Dec 01, 2002
|
SSA
|
SSA
322
|
Beneficiary Interview & Auditor's Observations
|
Form Only
|
May 01, 2001
|
SSA
|
SSA
3288
|
Privacy and Disclosure of Official Records and Information
|
Both Form and Instructions
|
May 01, 2007
|
SSA
|
SSA
3368
BK
|
Disability Report, Adult
|
Both Form and Instructions
|
Feb 01, 2004
|
SSA
|
SSA
3369
BK
|
Work History Report
|
Both Form and Instructions
|
Jan 01, 2005
|
SSA
|
SSA
3380
BK
|
Function Report - Adult Third Party
|
Both Form and Instructions
|
Jul 01, 2004
|
SSA
|
i
3441
|
Disability Report--Appeal
|
Both Form and Instructions
|
|
SSA
|
SSA-
3441
-BK (EDCS Screens)
|
Disability Report--Appeal (EDCS Screens)
|
Form Only
|
|
SSA
|
i
3441
(iAppeals)
|
Disability Report--Appeal (i3441--Revisions to the Screening Questions for Use with the New iAppeals Program)
|
Both Form and Instructions
|
|
SSA
|
SSA
3441
BK
|
Disability Report - Appeal
|
Both Form and Instructions
|
Jan 01, 2005
|
SSA
|
SSA
3462
|
Record of SSI Inquiry
|
Form Only
|
Dec 01, 1999
|
SSA
|
SSA
3820
BK
|
Disability Report, Child
|
Both Form and Instructions
|
Jul 01, 2003
|
SSA
|
SSA
3881
BK
|
Questionnaire for Children Claiming SSI Benefits
|
Form Only
|
Jun 01, 2003
|
SSA
|
SSA
3885
|
Government Pension Questionnaire
|
Form Only
|
Aug 01, 1999
|
SSA
|
SSA
3961
|
State Contribution Return
|
Both Form and Instructions
|
Apr 01, 1984
|
SSA
|
SSA
4156
|
Employee Identification Statement
|
Form Only
|
Sep 01, 1989
|
SSA
|
SSA
4162
|
Child Care Drop Out Years
|
Form Only
|
Apr 01, 2005
|
SSA
|
SSA
4178
|
Marital Relationship Questionnaire
|
Form Only
|
Dec 01, 2000
|
SSA
|
SSA
4184
0
|
Self-Employment-Cooperative Officer Questionnaire
|
Form Only
|
Jan 01, 1991
|
SSA
|
SSA
4290
|
Claimant's Recent Medical Treatment
|
Form Only
|
Jul 01, 2005
|
SSA
|
SSA
437
BK
|
Discrimination Complaint Form
|
Both Form and Instructions
|
Mar 01, 2006
|
SSA
|
SSA
4513
|
State Agency Report of Obligations for SSA Disability Programs
|
Both Form and Instructions
|
Jun 01, 2001
|
SSA
|
SSA
4514
|
State Agency Report of Obligations for SSA Disability Programs
|
Both Form and Instructions
|
Jun 01, 2002
|
SSA
|
SSA
454
BK
|
Report of Continuing Disability Interview
|
Form Only
|
Apr 01, 2006
|
SSA
|
SSA
455
|
Disability Update Report
|
Form Only
|
Aug 01, 2002
|
SSA
|
SSA
4588
OP6
|
You Can Make Your Payment by Credit Card
|
Both Form and Instructions
|
Aug 01, 2004
|
SSA
|
SSA
4589
OP6
|
You Can Make Your Payment by Credit Card
|
Both Form and Instructions
|
Aug 01, 2004
|
SSA
|
HA
4608
|
Waiver of Your Right to Personal Appearance - Hearing
|
Form Only
|
Mar 01, 2003
|
SSA
|
HA
4631
|
Claimant's Recent Medical Treatment
|
Form Only
|
Aug 01, 1996
|
SSA
|
HA
4632
|
Claimant's Medications
|
Form Only
|
Feb 01, 1994
|
SSA
|
HA
4633
|
Claimant's Work Background
|
Form Only
|
Mar 01, 1994
|
SSA
|
SSA
4641
U2
|
Authorization for the Social Security Administration to Obtain Records from a Financial Institution and Request for Records
|
Form Only
|
Jun 01, 2003
|
SSA
|
SSA
4659
F4
|
RSI/DI Quality Review Case Analysis - Sampled Number Holder
|
Form Only
|
Sep 01, 1999
|
SSA
|
SS
5
|
Application for a Social Security Card
|
Both Form and Instructions
|
May 01, 2006
|
SSA
|
SSA
5
F6
|
Application for Mother's or Father's Insurance Benefit
|
Instructions Only
|
Jan 01, 2006
|
SSA
|
HA
501
U5
|
Request for Hearings by Administrative Law Judge
|
Form Only
|
May 01, 2007
|
SSA
|
SSA
5062
|
Claimant's Statement About Loan of Food or Shelter Statement About Food or Shelter Provided to Another
|
Form Only
|
Apr 01, 2006
|
SSA
|
SSA
512
|
Request to Resolve Questionable Quarters of Coverage (QC)
|
Form Only
|
Sep 01, 1997
|
SSA
|
SSA
513
|
Request to Resolve Questionable Quarters of Coverage (QC)
|
Form Only
|
Sep 01, 1997
|
SSA
|
HA
520
U5
|
Request for Review of Hearing Decision/Order
|
Form Only
|
May 01, 2003
|
SSA
|
SSA
521
|
Request for Withdrawal of Application
|
Form Only
|
Jul 01, 2003
|
SSA
|
HA
539
|
Notice Regarding Substitution of Party Upon Death of Claimant
|
Form Only
|
Nov 01, 1990
|
SSA
|
SSA
545
BK
|
Plan for Achieving Self-Support
|
Form Only
|
Nov 01, 2005
|
SSA
|
SSA
546
|
Worker's Compensation/Public Disability Benefit Questionnaire
|
Form Only
|
Jun 01, 2004
|
SSA
|
SSA
561
U2
|
Request for Reconsideration
|
Form Only
|
Jul 01, 2003
|
SSA
|
SSA
5665
BK
|
Teacher Questionnaire
|
Form Only
|
Jan 01, 2006
|
SSA
|
SSA
5666
|
Request for Administrative Information
|
Form Only
|
Jan 01, 2006
|
SSA
|
SSA
58
|
MDCDISP/OD Modified Benefits Formula Questionnaire, Employer
|
Form Only
|
Nov 01, 1998
|
SSA
|
SSA
581
|
Authorization to Obtain Earning Data from the Social Security Administration
|
Form Only
|
Jan 01, 2002
|
SSA
|
SSA
612
|
Report of New Information in Disability Cases
|
Form Only
|
Jun 01, 2000
|
SSA
|
SSA
623
F6
|
Representative Payee Report
|
Both Form and Instructions
|
Sep 01, 2001
|
SSA
|
SSA
6230
F6
|
Representative Payee Report
|
Both Form and Instructions
|
Sep 01, 2003
|
SSA
|
SSA
6233
BK
|
Representative Payee Report of Benefits and Dedicated Account
|
Both Form and Instructions
|
Oct 01, 1997
|
SSA
|
SSA
624
F5
|
Representative Payee Evaluation Report
|
Form Only
|
Mar 01, 1990
|
SSA
|
SSA
625
|
Report by Former Representative Payee
|
Form Only
|
Dec 01, 1985
|
SSA
|
SSA
632
BK
|
Request for Waiver of Overpayment Recovery or Change in Repayment Rate
|
Form Only
|
Dec 01, 2002
|
SSA
|
SSA
637
|
Expanded Monitoring Program Site Review Questionnaire For Volume Payees
|
Form Only
|
Feb 01, 2005
|
SSA
|
SSA
638
|
Site Review Questionnaire For Volume Payees
|
Form Only
|
Nov 01, 2001
|
SSA
|
SSA
639
|
Site Review Questionnaire for Fee-for-Service Payees
|
Form Only
|
Nov 01, 2001
|
SSA
|
HA-
66
|
Request for Evidence from Doctor
|
Form Only
|
|
SSA
|
HA-
67
|
Request for Evidence from Hospital
|
Form Only
|
|
SSA
|
SSA
671
|
Railroad Employment Questionnaire
|
Form Only
|
Mar 01, 2005
|
SSA
|
SSA
7
F6
|
Application for Parent's Insurance Benefits
|
Instructions Only
|
Mar 01, 2006
|
SSA
|
SSA
7004
SM
|
Request for Earnings and Benefit Estimate Statement; Request for Earnings and Benefit Statement - SP
|
Both Form and Instructions
|
Jan 01, 2003
|
SSA
|
SSA
7008
|
Request for Correction of Earnings Record
|
Form Only
|
May 01, 1988
|
SSA
|
SSA
7011
F4
|
Statement of Employer
|
Both Form and Instructions
|
Mar 01, 1990
|
SSA
|
SSA
702
|
Statement Regarding Date of Birth and Citizenship
|
Form Only
|
Sep 01, 1982
|
SSA
|
SSA-
7050-F4
|
Request fo Social Security Earning Information
|
Form Only
|
|
SSA
|
SSA
7104
|
Partnership Questionnaire
|
Form Only
|
Apr 01, 1986
|
SSA
|
SSA
7156
|
Farm Self - Employment Questionnaire
|
Form Only
|
Apr 01, 2005
|
SSA
|
SSA
7157
F4
|
Farm Arrangement Questionnaire
|
Form Only
|
Jan 01, 1985
|
SSA
|
SSA
7160
F4
|
Employment Relationship Questionnaire
|
Form Only
|
Dec 01, 1987
|
SSA
|
SSA
7161
OCR-SM
|
Report to United States Social Security Administration by Person Receiving Benefits for a Child
|
Form Only
|
Mar 01, 2004
|
SSA
|
SSA
7162
OCR-SM
|
Report to United States Social Security Administration by Person Receiving Benefits for an Adult Unable to Handle Funds
|
Form Only
|
Apr 01, 2004
|
SSA
|
SSA
7163
|
Questionnaire About Employment or Self-Employment Outside the United States
|
Form Only
|
Aug 01, 2001
|
SSA
|
SSA
7163
A-F4
|
Supplemental Statement Regarding Farm Activities of Persons Living Outside the U.S.A.
|
Form Only
|
Aug 01, 2001
|
SSA
|
SSA
721
|
Statement of Death by Funeral Director
|
Form Only
|
May 01, 2005
|
SSA
|
SSA
723
F4
|
Statement Regarding the Inferred Death of an Individual by Reason of Continued & Unexplained Absence
|
Form Only
|
Mar 01, 1992
|
SSA
|
SSAL
725
|
Letter to Employer Requesting Information about Wages Earned
|
Both Form and Instructions
|
Feb 01, 1996
|
SSA
|
SSA
753
|
Statement Regarding Marriage
|
Form Only
|
Aug 01, 1984
|
SSA
|
SSA
754
F4
|
Statement of Marital Relationship
|
Form Only
|
Jun 01, 2006
|
SSA
|
SSA
760
F4
|
Certificate of Support
|
Form Only
|
Nov 01, 1983
|
SSA
|
SSA
765
|
Response to Notice of Revised Determination
|
Form Only
|
Jun 01, 1989
|
SSA
|
SSA
766
|
Statement of Self-Employment Income
|
Form Only
|
May 01, 1983
|
SSA
|
SSA
769
U4
|
Request For Change In Time/Place of Disability Hearing
|
Form Only
|
Apr 01, 1984
|
SSA
|
SSA
770
U4
|
Notice Regarding Substitution of Party Upon Death of Claimant Reconsideration of Disability of Cessation
|
Form Only
|
Apr 01, 1992
|
SSA
|
SSA
781
|
Certificate of Responsibility for Welfare and Care of Child Not in Applicant's Custody
|
Form Only
|
Oct 01, 1983
|
SSA
|
SSA
783
|
Statement Regarding Contributions
|
Form Only
|
Jan 01, 1990
|
SSA
|
SSA
788
F4
|
Statement of Care and Responsibility for Beneficiary
|
Form Only
|
Aug 01, 2004
|
SSA
|
SSA
789
U4
|
Request for Reconsideration - Disability Cessation
|
Form Only
|
Mar 01, 2003
|
SSA
|
SSA
795
|
Statement of Claimant or Other Person
|
Form Only
|
Aug 01, 2002
|
SSA
|
SSA
8
F4
|
Application for Lump-Sum Death Payment
|
Instructions Only
|
May 01, 2003
|
SSA
|
SSA
8000
BK
|
Application for Supplemental Security Income
|
Form Only
|
May 01, 1990
|
SSA
|
SSA
8006
F4
|
Statement of Living Arrangements, In-Kind Support and Maintenance
|
Form Only
|
Aug 01, 2004
|
SSA
|
SSA
8010
BK
|
Statement of Income and Resources
|
Form Only
|
Sep 01, 2004
|
SSA
|
SSA
8011
F3
|
Statement of Household Expenses and Contributions
|
Form Only
|
Jun 01, 1989
|
SSA
|
SSA
8019
U2
|
Third-Party Liability Information Statement
|
Form Only
|
May 01, 2003
|
SSA
|
SSA
8060
U3
|
Agreement to Sell Property
|
Form Only
|
Oct 01, 1987
|
SSA
|
SSA
8125
|
SSI Notice of Interim Assistance Reimbursement
|
Both Form and Instructions
|
Oct 01, 1997
|
SSA
|
SSA
8150
EV
|
Reporting Events, SSI
|
Instructions Only
|
Jun 01, 1981
|
SSA
|
SSA
820
F4
|
Work Activity Report
|
Form Only
|
Feb 01, 1991
|
SSA
|
SSA
8202
BK
|
Statement for Determining Continuing Eligibility for Supplemental Security Income Payments
|
|
May 01, 2003
|
SSA
|
SSA
8203
BK
|
Statement for Determining Continuing Eligibility for Supplemental Security Income Payments
|
Both Form and Instructions
|
May 01, 2003
|
SSA
|
SSA
821
BK
|
Work Activity Report, Employee
|
Both Form and Instructions
|
Mar 01, 2001
|
SSA
|
SSA
824
|
Report on Individual with Mental Impairment
|
Both Form and Instructions
|
Nov 01, 1991
|
SSA
|
SSA
827
|
Authorization for Source to Release Information to SSA
|
Form Only
|
Jun 01, 2006
|
SSA
|
SSA-
832-C3/U3
|
Cessation or Continuance of Disability or Blindness Determination and Transmittal
|
Form Only
|
|
SSA
|
SSA
8508
BK
|
Supplemental Security Income, Quality Review Case Analysis
|
Form Only
|
Jun 01, 2006
|
SSA
|
SSA
871
|
State Agency Report of Obligations for SSA Disability Programs
|
Both Form and Instructions
|
Jun 01, 2001
|
SSA
|
SSA
95
EP
|
Missing and Discrepant Wage Reports Letter and Questionnaire --- Missing and Discrepant Wage Reports Letter and Questionnaire --- Missing and Discrepant Wage Reports Letter and Questionnaire
|
Form Only
|
Feb 01, 1992
|
SSA
|
SSA
96
BK
|
Instructions for Completion of Federal Assistance Application Form SSA-96 for SSA Research and Demonstration Grant Programs
|
Both Form and Instructions
|
Mar 01, 2000
|
SSA
|
SSA
97
EP
|
Missing and Discrepant Wage Reports Letter and Questionnaire --- Missing and Discrepant Wage Reports Letter and Questionnaire --- Missing and Discrepant Wage Reports Letter and Questionnaire
|
Both Form and Instructions
|
Feb 01, 1992
|
SSA
|
SSA
9741
F3
|
Quarterly Statistical Report on Recipients and Payments under State-administered Assistance Programs for Aged, Blind, and Disabled
|
Form Only
|
Mar 01, 2002
|
SSA
|
Internet Direct Deposit
|
Internet Direct Deposit
|
Both Form and Instructions
|
|
SSA
|
SSA
L2765
C1
|
Request for Self-Employment
|
Both Form and Instructions
|
Feb 01, 1997
|
SSA
|
SSA
L2794
|
Real Property Current Market Value Estimate
|
Form Only
|
Aug 01, 1989
|
SSA
|
SSA
L3231
C1
|
Employer Verification or Records for Children under Age 7
|
Both Form and Instructions
|
Apr 01, 1998
|
SSA
|
SSA
L3365
C1
|
Request for Self-Employment
|
Both Form and Instructions
|
Feb 01, 1997
|
SSA
|
SSA
L4002
C1
|
Request for Self-Employment
|
Both Form and Instructions
|
Feb 01, 1997
|
SSA
|
SSA
L4112
C1
|
Employer Verification of Earnings After Death
|
Both Form and Instructions
|
Apr 01, 1999
|
SSA
|
SSA
L4163
|
Agency/Employer Questionnaire
|
Both Form and Instructions
|
Dec 01, 2000
|
SSA
|
SSA
L4201
F4
|
Letter to Employer Requesting Wage Information
|
Form Only
|
Jun 01, 2000
|
SSA
|
SSA
L4945
U2
|
Contact with Rep Payee, Contact with Beneficiary
|
Form Only
|
Nov 01, 1982
|
SSA
|
SSA
L4947
U2
|
Contact with Rep Payee, Contact with Beneficiary
|
Form Only
|
Sep 01, 1987
|
SSA
|
SSA
L5061
|
Letter to Landlord Requesting Rental Information
|
Both Form and Instructions
|
Aug 01, 1996
|
SSA
|
SSA
L5063
|
Claimant's Statement About Loan of Food or Shelter Statement About Food or Shelter Provided to Another
|
Form Only
|
Aug 01, 1994
|
SSA
|
SSA
L711
|
Request for Address Information from Employment Commissions
|
Form Only
|
Sep 01, 1993
|
SSA
|
SSA
L712
|
Request for Address Information from Motor Vehicle Records
|
Form Only
|
Sep 01, 1983
|
SSA
|
SSA
L8050
U3
|
Supplemental Security Income Claim Information Notice
|
Both Form and Instructions
|
Dec 01, 1991
|
SSA
|
SSA
L8125
F6
|
SSI Notice of Interim Assistance Reimbursement
|
Both Form and Instructions
|
Oct 01, 1997
|
SSA
|
SSA
L93
SM
|
Missing and Discrepant Wage Reports Letter and Questionnaire --- Missing and Discrepant Wage Reports Letter and Questionnaire --- Missing and Discrepant Wage Reports Letter and Questionnaire
|
Both Form and Instructions
|
Feb 01, 1993
|
SSA
|
SSA
L9778
SM-SUP
|
Mid-Year Mailer
|
Both Form and Instructions
|
Jul 01, 2004
|
SSA
|
SSA
L9779
SM-SUP
|
Mid-Year Mailer
|
Both Form and Instructions
|
Jul 01, 2004
|
SSA
|
SSA
L9781
SM
|
Mid-Year Mailer
|
Both Form and Instructions
|
Jun 01, 2002
|
SSA
|
N/A
|
EVS Registration Form
|
Form Only
|
|
SSA
|
N/A
|
Internet Application Status
|
Both Form and Instructions
|
|
SSA
|
SSA
i0554
|
Certificate of Coverage Request
|
Both Form and Instructions
|
Aug 02, 2002
|
SSA
|
SSA
i0583
0
|
Request for Replacement SSA-1099/SSA-1042S Social Security Benefits Statement
|
Both Form and Instructions
|
|
SSA
|
SSA
i0595
|
Electronic Benefit Verification Information
|
Both Form and Instructions
|
|
SSA
|
SSA
i0618
|
Internet Social Security Benefit Application (ISBA)
|
Both Form and Instructions
|
|
SSA
|
SSA
i0650
|
Internet Social Security Disability Report (ISSDR)
|
Both Form and Instructions
|
|
SSA
|
SSA
i3820
|
Internet Social Security Disability Report - Child
|
Both Form and Instructions
|
|
|
|