SSA Forms Directory | SOAR Works

SS-5 Application for a Social Security Card

SS-5-FS Application for a Social Security Card (Outside of the U.S.)

CMS-40B Application for Enrollment in Medicare - Part B (Medical Insurance)

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CMS-1763 Request for Termination of Premium Part A, Part B, or Part B Immunosuppressive Drug Coverage

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CMS-L564 Request for Employment Information

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HA-85 Request to Withdraw a Hearing Request

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HA-86 Request to Withdraw an Appeals Council Request for Review

HA-501-U5 Request for Hearing by Administrative Law Judge

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HA-510 Waiver of Timely Written Notice of Hearing

HA-520 Request for Review of Hearing Decision/Order

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HA-539 Notice Regarding Substitution of Party Upon Death of Claimant

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HA-4608 Waiver of Your Right to Personal Appearance Before an Administrative Law Judge

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HA-4631 Claimant's Recent Medical Treatment

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HA-4632 Claimant's Medications

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HA-4633 Claimant's Work Background

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HA-L90 Request To Show Cause For Failure To Appear

IRS SS-4 Application for Employer Identification Number

IRS W-4V Voluntary Withholding Request

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SSA-1-BK Application for Retirement Insurance Benefits

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SSA-2-BK Application for Wife's or Husband's Insurance Benefits

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SSA-3 Marriage Certification

SSA-4-BK Application for Child's Insurance Benefits

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SSA-5-BK Application For Mother's Or Father's Insurance Benefits

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SSA-7-F6 Application for Parent's Insurance Benefits

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SSA-8 Application for Lump-Sum Death Payment

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SSA-10 Application for Widow's or Widower's Insurance Benefits

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SSA-16 Application for Disability Insurance Benefits

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

SSA-24 Application for Survivors Benefits (Payable Under Title II of the Social Security Act)

SSA-25 Certification of Election for Reduced Spouse's Benefits

SSA-44 Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event

SSA-88 Pre-Approval Form for Consent Based Social Security Number Verification (CBSV)

SSA-89 Authorization for the Social Security Administration To Release Social Security Number (SSN) Verification

SSA-131 Employer Report of Special Wage Payments

SSA-150 Modified Benefits Formula Questionnaire

SSA-186 Temporary Institutionalization Statement to Maintain Household and Physician Certification

SSA-199 Vocational Rehabilitation Provider Claim

SSA-263 Waiver of Supplemental Security Income Payment Continuation

SSA-268 Patient Acknowledgement Form for Influenza Vaccination

SSA-295 Disability Determination Ready Claim Certification

SSA-308 Modified Benefits Formula Questionnaire, Foreign Pension

SSA-371 Request For Reinstatement - Title II

SSA-372 Request For Reinstatement - Title XVI

SSA-437-BK Complaint Form for Allegations of Discrimination in Programs or Activities Conducted by the Social Security Administration

SSA-454-BK Continuing Disability Review Report

SSA-455 Disability Update Report

SSA-455-OCR-SM Disability Update Report (Online Version)

SSA-521 Request for Withdrawal of Application

SSA-545-BK Plan for Achieving Self-Support

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SSA-546 Worker's Compensation/Public Disability Questionnaire

SSA-552 Dedicated Account Use of Funds Statement

SSA-561 Request for Reconsideration

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SSA-632-BK Request for Waiver of Overpayment Recovery

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SSA-634 Request for Change in Overpayment Recovery Rate

SSA-640 Financial Disclosure for Civil Monetary Penatly (CMP) Debt

SSA-671 Railroad Employment Questionnaire

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-723 Statement Regarding the Inferred Death of an Individual by Reason of Continued and Unexplained Absence

SSA-731 Notice to Electronic Information Exchange Partners to Provide Contractor List

SSA-753 Statement Regarding Marriage

SSA-754-F5 Statement of Marital Relationship

SSA-760 Certificate of Support

SSA-765 Response to Notice of Revised Determination

SSA-766 Statement of Self-Employment Income

SSA-769 Request for Change in Time/Place of Disability Hearing

SSA-770-U4 Notice Regarding Substitution of Party Upon Death of Claimant Reconsideration of Disability Cessation

SSA-773 Waiver Of Right To Appear - Disability Hearing

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

SSA-783 Statement Regarding Contributions

SSA-788 Statement of Care and Responsibility for Beneficiary

SSA-789 Request for Reconsideration - Disability Cessation

SSA-792 Statutory Benefit Continuation Election Statement

SSA-795 Statement of Claimant or Other Persons

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

SSA-821-BK Work Activity Report

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

SSA-1020 Application For Help With Medicare Prescription Drug Plan Costs

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SSA-1021 Appeal of Determination for Extra Help with Medicare Prescription Drug Plan Costs

SSA-1199 International Direct Deposit (IDD)

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SSA-1372-BK Advanced Notice of Termination of Child's Benefits

SSA-1372-BK-FC Advanced Notice of Termination of Child's Benefits (Foreign Claims)

SSA-1383 Student Reporting Form

SSA-1383-FC Reporting to Social Security Administration by Student Outside the United States

SSA-1391 Employment Network Payment Request Form

SSA-1458 Certification By Religious Group

SSA-1560 Petition For Authorization To Charge And Collect A Fee For Services Before The Social Security Administration

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SSA-1691 Eligible Non-Attorney Representative Application

SSA-1693 Fee Agreement for Representation Before the Social Security Administration

SSA-1694 Request for Business Entity Taxpayer Information

SSA-1696 Claimant's Appointment of Representative

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SSA-1696-SUP1 Claimant's Revocation of the Appointment of a Representative

SSA-1696-SUP2 Representative's Withdrawal of Acceptance of Appointment

SSA-1699 Registration for Appointed Representative Services and Direct Payment

SSA-1724-F4 Claim for Amounts due in case of a Deceased Beneficiary

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SSA-1945 Statement Concerning Your Employment in a Job Not Covered by Social Security

SSA-2010 Statement for Determining Continuing Entitlement for Special Veterans Benefits (SVB)

SSA-2032-BK Request for Waiver of Special Veterans Benefits (SVB) Overpayment Recovery or Change in Repayment Rate

SSA-2490 Application For Benefits Under a U.S. International Social Security Agreement

SSA-2512 Pre-1957 Military Service Federal Benefit Questionnaire

SSA-2519 Child Relationship Statement

SSA-2574 Information About Joint Checking/Savings Accounts Supplemental Security Income

SSA-2855 Statement of Funds you Received

SSA-2935 Authorization to the Social Security Administration to Obtain Personal Information

SSA-3033 Employee Work Activity Questionnaire

SSA-3105 Important information about your appeal, waiver rights, and repayment options

SSA-3288 Consent for Release of Information

SSA-3288-OP1 Consent for Disclosure of Records Protected Under the Privacy Act

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SSA-3368-BK Disability Report - Adult

SSA-3369-BK Work History Report

SSA-3373-BK Function Report - Adult

SSA-3375-BK Function Report - Child Birth to 1st Birthday

SSA-3376-BK Function Report - Child Age 1 to 3rd Birthday

SSA-3377-BK Function Report - Child Age 3 to 6th Birthday

SSA-3378-BK Function Report - Child Age 6 to 12th Birthday

SSA-3379-BK Function Report - Child Age 12 to 18th Birthday

SSA-3380-BK Function Report - Adult - Third Party Form

SSA-3441-BK Disability Report - Appeal

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SSA-3820-BK Disability Report - Child

SSA-3830 Certification of Low Birth Weight for SSI Eligibility

SSA-3881-BK Questionnaire for Children Claiming SSI Benefits

SSA-3885 Government Pension Questionnaire

SSA-4111 Certification of Election for Reduced Widow(er)'s and Surviving Divorced Spouse's Benefits

SSA-4162 Child Care Dropout Questionnaire

SSA-4178 Marital Relationship Questionaire

SSA-4290-F5 Development Of Participation In Vocational Rehabilitation or Similar Program

SSA-4814 Medical Report on Adult with Allegation of Human Immunodeficiency Virus (HIV) Infection

SSA-4815 Medical Report on Child with Allegation of Human Immunodeficiency Virus (HIV) Infection

SSA-5062 Claimant's Statement about Loan of Food or Shelter

SSA-5064 Claimant's Statement About Loan For Shelter

SSA-5665-BK Teacher Questionnaire

SSA-5666 Request for Administrative Information

SSA-7004 Request for Social Security Statement

SSA-7008 Request for Correction of Earnings Record

SSA-7011-F4 Statement of Employer

SSA-7050-F4 Request for Social Security Earnings Information

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SSA-7104 Partnership Questionnaire

SSA-7156 Farm Self Employment Questionnaire

SSA-7157-F4 Farm Arrangement Questionnaire

SSA-7160 Employment Relationship Questionnaire

SSA-7163 Questionnaire about Employment or Self Employment

SSA-7163A Supplemental Statement Regarding Farming Activities

SSA-8000-BK Application for Supplemental Security Income (SSI)

SSA-8001-BK Application for Supplemental Security Income (SSI) (Deferred or Abbreviated)

SSA-8005 Supplemental Security Income (SSI) Reporting Responsibilities

SSA-8011-F3 Statement of Household Expenses and Contributions

SSA-8240 Authorization for the Social Security Administration to Obtain Wage and Employment Information from Payroll Data Providers

SSA-8510 Authorization for the Social Security Administration to Obtain Personal Information

SSA-8552 Interview Confirmation