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Social Security Administration – SSA

Benefit Claims Supporting Forms:

SSA-3 Marriage Certification

SSA-11 Request to be Selected as Payee

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

SSA-25 Certificate of Election for Reduced Spouse’s Benefits

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 Questionaire

SSA-604 Certificate of Incapacity

SSA-671 Railroad Employment Questionnaire

SSA-723 Statement Regarding the Inferred Death of an Individual

SSA-754 Statement of Marital Relationship

SSA-760 Certificate of Support

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

SSA-783 Statement Regarding Contributions

SSA-789 Request for Reconsideration – Disability Cessation

SSA-795 Statement of Claimant or Other Persons

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

SSA-821-BK Work Activity Report

SSA-827 Authorizations to Disclose Information to SSA

SSA-1372-BK Advance Notice of Termination of Child’s Benefits

SSA-2032-BK Request for Waiver of Special Veterans Benefits (SVB)

SSA-2512 Pre-1957 Military Service Federal Benefit Questionaire

SSA-2519 Child Relationship Statement

SSA-3369 Work History Report

SSA-3441-BK Disability Report-Appeal

SSA-3820 Disability Report Child

SSA-3881 Questionaire for Children Claiming SSI Benefits

SSA-3885 Government Pension Questionaire

SSA-4111 Certificate of Election for Reduced Widow’s or Widower’s Benefits

SSA-4162 Child Care Dropout Questionaire

SSA-4184 Self Employment Corporate Officer Questionaire

SSA-5665-BK Teacher Questionaire

SSA-5666 Request for Administrative Information

SSA-7008 Request for Correction of Earnings Record

SSA-7104 Partnership Questionaire

SSA-7156 Farm Self Employment Questionaire

SSA-7157 Farm Arrangement Questionaire

SSA-7163 Questionaire About Employment or Self Employment

SSA-7163A Supplemental Statement Regarding Farming Activities


Inside Social Security Administration – SSA