Social Security Forms

All forms are FREE. Not all forms are listed. If you can’t find the form you need, call us at 1-800-772-1213 (TTY 1-800-325-0778) or contact us. If you need help completing a form, please contact us and we will help you.

Online Forms (fill out and submit online)

• Apply for retirement, spouse's or Medicare benefits
• Apply for disability benefits
• SSA-3368 Adult Disability Report
• Child Disability Report
• Appeal a recent medical decision
• Apply Online for Extra Help with Medicare Prescription Drug Plan Costs
• Get a replacement Medicare card
• Request a proof of Social Security benefits letter
• Request a form SSA-1099/1042 (Benefit Statement) for tax or other purposes
• Request for Social Security Statement
• Sign up for or change direct deposit
• Change address or telephone number
• Request special notices for the blind or visually impaired

Medicare Forms

• SSA-44 Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event
• SSA-54 Authorization for SSA to Disclose Tax Information for Your Appeal of Your Medicare Part B Income-Related Monthly Adjustment Premium Amount
• SSA-1020B-INST General Instructions for Completing the Application for Extra Help with Medicare Prescription Drug Plan Costs
• SSA-1021 Appeal of Determination for Help with Medicare Prescription Drug Costs
• SSA-1021-INST Instructions for Completing the Appeal of Determination for Help with Medicare
• SSA-1021-SP Apelación de la determinación para recibir ayuda con los gastos de los Planes
• SSA-1021-INST-SP Instrucciones - Apelación de la determinación para recibir ayuda con los gastos

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Disability Forms

• SSA-827 Authorization to Disclose Information to the Social Security Administration
• SSA-199 Vocational Rehabilitation Provider Claim
• SSA-545 Plan for Achieving Self-Support
• SSA-546 Worker's Compensation/Public Disability Questionnaire
• SSA-820 Work Activity Report (Self-Employed Person)
• SSA-821 Work Activity Report
• SSA-1365 State Agency Ticket Assignment Form Ticket To Work and Self Sufficiency Program
• SSA-3368 Disability Report Adult
• SSA-3369 Work History Report
• SSA-3373 Function Report-Adult
• SSA-3375 Function Report-Child Birth to 1st Birthday
• SSA-3380 Function Report Adult-Third Party Form
• SSA-3381 Medical and Job Worksheet Adult
• SSA-3820 Disability Report, Child
• SSA-3881 Questionnaire for Children Claiming SSI Benefits
• SSA-5665 Teacher Questionnaire

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Reconsideration and Appeals Forms

• SSA-561 Request for Reconsideration
• SSA-789 Request for Reconsideration - Disability Cessation
• SSA-3441 Disability Report-Appeal
• HA-501 Request for Hearing by Administrative Law Judge
• HA-520 Request for Review of Decision/Order of Administrative Law Judge
• HA-539 Notice Regarding Substitution of Party Upon Death of Claimant
• HA-4608 Waiver of Your Right to Personal Appearance Before an Administrative Law Judge
• HA-4631 Claimant's Recent Medical Treatment
• HA-4632 Claimant's Medications
• HA-4633 Claimant's Work Background

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Benefit Application Supporting Forms

Generally, we use these forms for people who have applied for benefits or are applying. We will let you know when you need to complete one of these forms.

• SSA-3 Marriage Certification
• SSA-3-SP Certificación de Matrimonio
• SSA-11 Request to Be Selected As Payee
• SSA-21 Supplement to Claim of Person Outside the United States
• SSA-25 Certification of Election for Reduced Spouse's Benefits
• SSA-150 Modified Benefits Formula Questionnaire
• SSA-308 Modified Benefits Formula Questionnaire, Foreign Pension
• SSA-437 Complaint Form for Allegations of Discrimination in Programs or Activities Conducted by the Social Security Administration
• SSA-521 Request for Withdrawal of Application
• 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-783 Statement Regarding Contributions
• SSA-787 Physician's/Medical Officer's Statement of Patient's Capability to Manage Benefits
• SSA-795 Statement of Claimant or Other Persons
• SSA-1372 Advanced Notice of Termination of Child's Benefits
• SSA-1372-BK-FC Advance Notice of Termination of Child’s Benefits (Foreign Claims)
• SSA-2032 Request for Waiver of Special Veterans Benefits (SVB) Overpayment Recovery or Change in Repayment Rate
• SSA-2512 Pre-1957 Military Service Federal Benefit Questionnaire
• SSA-2519 Child Relationship Statement
• SSA-3885 Government Pension Questionnaire
• SSA-4111 Certification of Election for Reduced Widow(er)'s and Surviving Divorced Spouse's Benefits
• SSA-4184 Self Employment Corporate Officer Questionnaire
• SSA-5666 Request for Administrative Information
• 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

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Other Social Security Forms

These forms are used for many of our programs and services. Each form has instructions.

• SS-5 Application for a Social Security Card
• SS-5-FS Application for a Social Security Card
• SS-5-SP Solicitud Para una Tarjeta de Seguro Social
• SSA-89 Authorization for the Social Security Administration To Release Social Security Number (SSN) Verification
• SSA-117 How Are We Doing?
• SSA-131 Employer Report of Special Wage Payments
• SSA-604 Certificate of Incapacity
• SSA-632 Request for Waiver of Overpayment Recovery or Change in Repayment Rate
• SSA-L706 Letter to Custodian of Birth Records
• SSA-711 Request for Deceased Individual's Social Security Record
• SSA-714 You Can Make Your Payment By Credit Card
• SSA-721 Statement of Death by Funeral Director
• SSA-753 Statement Regarding Marriage
• SSA-753-SP Declaracion Acerca De Matrimonio
• SSA-754 Statement of Marital Relationship
• SSA-1560 Petition to Obtain Approval of a Fee For Representing a Claimant Before the Social Security Administration
• SSA-1694 Request for Business Entity Taxpayer Information
• SSA-1695 Identifying Information for Possible Direct Payment of Authorized Fees
• SSA-1696 Appointment of Representative
• SSA-1699 Registration for Appointed Representative Services and Direct Payment
• SSA-1724 Claim For Amounts Due In Case Of A Deceased Beneficiary
• SSA-1945 Statement Concerning Your Employment In a Job Not Covered by Social Security
• SSA- 2000 Application for Special Benefits for World War II Veterans
• SSA-3033 Retirement, Survivors and Disability Insurance Supplemental Security Income
• SSA-3288 Consent for Release of Information
• SSA-4162 Child Care Dropout Questionnaire
• SSA-L-4201 Letter to Employer Requesting Wage Information
• SSA-7004 Request for Social Security Statement
• SSA-7004-SP Solicitud de Declaración de Ganancias y Cálculo de Beneficios
• SSA-7050 Request for Social Security Earnings Information

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Information You Need to Apply for Benefits

If you live in the U.S. – You can complete an application for Retirement, Spouse's, Medicare, or Disability Benefits online. You can also call us at 1-800-772-1213 (TTY 1-800-325-0778) or visit your local office to apply for these or any other kind of benefits.

If you live outside the U.S., contact the nearest U.S. Social Security office, U.S. Embassy or consulate, or the Veterans Affairs Regional Office (VARO) in the Philippines.

To see the information you will need when you apply, select the type of benefits you want from the list below:

• Retirement Insurance Benefits
• Wife's or Husband's Insurance Benefits
• Child's Insurance Benefits
• Disability Insurance Benefits
• Widows/Widowers with Dependent Children Insurance Benefits
• Widow's or Widower's Insurance
• Dependent Parent's Insurance Benefits
• Lump-Sum Death Payment

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Forms from Other U.S. Government Agencies

The following are commonly requested forms from other agencies that we provide for your convenience. Any questions about these forms should be addressed to the agency that is responsible for the form.

• SF-1199A Direct Deposit Sign-Up Form, Financial Management Service Website
• IRS Form SS-4 Application for Employer Identification Number (SS-4), IRS Website
• IRS Form W-4V Voluntary Withholding Request, IRS Website
• IRS Form 6559 Transmitter Report and Summary of Magnetic Media, IRS Website
  

Other Government Forms at www.Forms.Gov

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Instructions for Printing Forms

SSA offers our forms 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. You can download the Adobe Acrobat Reader version suitable for your system by clicking on this button. There is no charge for this software.

SSA forms must be printed on 8 1/2" x 11" white paper. You must print the form with blue or black ink to be acceptable to SSA.

NOTE: if you live abroad, and cannot obtain 8.5 x 11 paper, the use of A4 size paper (8.25 x 11.7) is the only acceptable alternative.

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