Form SSA-521, the Request for Withdrawal of Application, serves as a request form for individuals who wish to withdraw their application for Social Security benefits. The primary purpose is to allow applicants to cancel their application for retirement, spouse's, or Medicare benefits that they previously filed for.
Form SSA-5062, Claimant's Statement about the Loan of Food or Shelter, is used to collect information from Supplemental Security Income (SSI) applicants or beneficiaries regarding the receipt of food or shelter. The main purpose of this form is to assess the value of support and maintenance that a claimant receives from others, which may affect their SSI eligibility and benefit amount.
Form SSA-4-INST, Reporting Responsibilities for Child's Insurance Benefits, serves as instructions for individuals who are receiving or applying for Child's Insurance Benefits under the Social Security program. The main purpose of these instructions is to provide guidance to beneficiaries on reporting responsibilities and requirements when receiving these benefits.
Form SSA-4-BK, the Application for Child's Insurance Benefits, serves as the application form for child's insurance benefits under the Social Security program. The primary purpose is to apply for benefits on behalf of a child who may be eligible to receive benefits based on a parent's work record.
Form SSA-4815, the Medical Report on a Child with an Allegation of Human Immunodeficiency Virus (HIV) Infection, is similar to Form SSA-4814 but is designed for children. Its main purpose is to collect medical information on a child who alleges having HIV infection to determine eligibility for HIV infection-related Social Security disability benefits.
Form SSA-4814, the Medical Report on an Adult with an Allegation of Human Immunodeficiency Virus (HIV) Infection, is used to report medical information regarding an adult who alleges having HIV infection. The primary purpose of this form is to collect medical information to determine eligibility for HIV infection-related Social Security disability benefits.
Form SSA-454-BK, the Continuing Disability Review Report, serves as a report for individuals receiving Social Security disability benefits. Its main purpose is to conduct a continuing disability review (CDR) to assess the current disability status of beneficiaries. The CDR helps determine whether individuals continue to meet the eligibility criteria for disability benefits.
Form SSA-437-BK, the Complaint Form for Allegations of Discrimination in Programs or Activities Conducted by the Social Security Administration, is used to report allegations of discrimination in programs or activities conducted by the Social Security Administration (SSA). The main purpose of this form is to provide a mechanism for individuals to report instances of discrimination.
Form SSA-4178, the Marital Relationship Questionnaire, is used to collect information about an individual's marital history and relationships that may affect their eligibility for Social Security benefits. The primary purpose of this form is to document details about marriages, divorces, and other relationships that could impact benefit eligibility.
Form SSA-4162, the Child Care Dropout Questionnaire, is used to collect information about periods when a parent or guardian had to reduce or stop work due to the need for childcare. The primary purpose of this form is to allow individuals to report interruptions in their work history caused by childcare responsibilities.
