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Social Security Administration (SSA) Forms

Social Security Administration Forms
Advance Notice Of Termination Of Child's Benefits [SSA-1372-BK] (rev. 02/02)
Application For A Social Security Card [SS-5] (rev. 10/03)
Application For A Social Security Card: Foreign Service [SS-5-FS] (rev. 10/03)
Application For Enrollment In Medicare [CMS-40B] (rev. 10/01)
Application For Federal Assistance [SSA-96] (rev. 04/94)
Application For Special Benefits For World War II Veterans [SSA-2000-F6] (rev. 02/00)
Appointment Of Representative [SSA-1696-BK] (rev. 04/02)
Authorization To Disclose Information To The Social Security Administration (SSA) [SSA-827] (rev. 07/03)
Certificate Of Responsibility For Welfare And Care Of Child [SSA-781] (rev. 10/00)
Child-Care Dropout Questionnaire [SSA-4162] (rev. 07/00)
Child Relationship Statement [SSA-2519] (rev. 11/03)
Claim For Amounts Due In The Case Of Deceased Beneficiary [SSA-1724] (rev. 07/00)
Claimant's Medications [HA-4632] (rev. 09/00)
Claimant's Recent Medical Treatment [HA-4631] (rev. 08/96)
Claimant's Work Background [HA-4633] (rev. 03/94)
Consent For Release Of Information [SSA-3288] (rev. 12/99)
Disability Report - Appeal [SSA-3441-BK] (rev. 02/04)
Disability Report Adult [SSA-3368-BK] (rev. 02/04)
Disability Report Child [SSA-3820-BK] (rev. 05/02)
Discrimination Complaint [SSA-437-BK] (rev. 04/98)
Employer Report Of Special Wage Payments [SSA-131] (rev. 06/02)
Farm Arrangement Questionnaire [SSA-7157-F4] (rev. 07/00)
Farm Self-Employment Questionnaire [SSA-7156] (rev. 07/00)
Government Pension Questionnaire [SSA-3885] (rev. 09/00)
Marriage Certification [SSA-3] (rev. 07/00)
Modified Benefit Formula Questionnaire [SSA-150] (rev. 03/99)
Modified Benefit Formula Questionnaire - Foreign Pension [SSA-308] (rev. 11/00)
Notice Of Intent Agreement [SSA-605-U5] (rev. 06/01)
Notice Regarding Substitution Of Party Upon Death Of Claimant [HA-539] (rev. 10/00)
Partnership Questionnaire [SSA-7104] (rev. 07/00)
Petition To Obtain Approval Of A Fee For Representing A Claimant Before The Social Security Administration [SSA-1560-U4] (rev. 07/00)
Physician's/Medical Officer's Statement Of Patient's Capability To Manage Benefits [SSA-787] (rev. 11/02)
Plan For Achieving Self-Support [SSA-545-BK] (rev. 02/99)
Pre-1957 Military Service - Federal Benefit Questionnaire [SSA-2512] (rev. 11/00)
Questionnaire About Employment Of Self-Employment Outside The United States [SSA-7163] (rev. 10/00)
Questionnaire For Children Claiming SSI Benefits [SSA-3881-BK] (rev. 01/03)
Railroad Employment Questionnaire [SSA-671] (rev. 06/02/00)
Reconsideration Disability Report [SSA-3441-F6] (rev. 03/99)
Request For Administrative Information [SSA-5666] (rev. 03/02)
Request For Correction Of Earning Record [SSA-7008] (rev. 12/01)
Request For Employment Information [CMS-L564] (rev. 04/00)
Request For Hearing Before Administrative Law Judge [HA-501-U5] (rev. 03/02)
Request For Reconsideration - Disability Cessation - Right To Appear [SSA-789-U4] (rev. 03/03)
Request For Reconsideration [SSA-561-U2] (rev. 07/03)
Request For Review Of Hearing Decision/Order [HA-520-U5] (rev. 04/02)
Request For Social Security Earning Information [SSA-7050-F4] (rev. 01/04)
Request For Social Security Statement [SSA-7004-SM] (rev. 08/02)
Request For Waiver Of Overpayment Recovery Or Change In Repayment Rate [SSA-632-BK] (rev. 04/03)
Request For Withdrawal Of Application [SSA-521] (rev. 05/00)
Self-Employment/Corporate Officer Questionnaire [SSA-4184] (rev. 01/02)
Solicitud De Declaracion De Seguro [SSA-7004-SM-SP] (rev. 08/02)
Solicitud Para Una Tarjeta De Seguro Social [SS-5-SP] (rev. 10/03)
Statement Of Care And Responsibility For Beneficiary [SSA-788-F4] (rev. 11/02)
Statement Of Claimant Or Other Person [SSA-795] (rev. 12/02)
Statement Regarding Contributions [SSA-783] (rev. 10/00)
Statement Regarding The Inferred Death Of An Individual By Reason Of Continued And Unexplained Absence [SSA-723-F4] (rev. 11/00)
Student's Statement Regarding School Attendance [SSA-1372-BK] (rev. 02/02)
Supplement To Claim Of Person Outside The United States [SSA-21] (rev. 11/00)
Supplemental Statement Regarding Farming Activities Of Person Living Outside The U.S.A. [SSA-7163A-F4] (rev. 11/00)
Teacher Questionnaire [SSA-5665-BK] (rev. 03/02)
Waiver Of Written Notice Of Hearing [HA-510] (rev. 11/00)
Waiver Of Your Right To Personal Appearance [HA-4608] (rev. 08/95)
Work Activity Report (Self-Employed Person) [SSA-820-F4] (rev. 07/00)
Work Activity Report - Employee [SSA-821-BK] (rev. 01/02)
Work History Report [SSA-3369-BK] (rev. 12/03)
Worker's Compensation/Public Disability Questionnaire [SSA-546] (rev. 09/00)


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