Form SSA-2935 serves as the Authorization to the Social Security Administration to Obtain Personal Information. The primary purpose of this form is to allow individuals to grant the SSA permission to collect personal information from other organizations or individuals. This authorization is often required to verify claims and eligibility for Social Security benefits.
Form SSA-2855 is the Statement of Funds You Received. The main purpose of this form is to document and report any funds received by an individual or household, which may impact their eligibility for certain Social Security benefits. The form is used to ensure that individuals accurately report their financial situation, which is essential for determining benefit eligibility and payment amounts.
Form SSA-2853-OP4 is the Message From Social Security - 10 Weeks. This form serves as a notice from the Social Security Administration to inform individuals that their Social Security benefits will be stopped in 10 weeks unless they provide evidence that they are still eligible for benefits. The purpose of this form is to notify individuals about a pending cessation of benefits and provide them with an opportunity to prove their continued eligibility.
Form SSA-268, the Patient Acknowledgment Form for Influenza Vaccination, is used to acknowledge receipt of the influenza vaccine by patients in healthcare facilities. The primary purpose of this form is to document that patients have received the flu vaccine, including the date and location of vaccination, as required by the Centers for Medicare & Medicaid Services (CMS).
Form SSA-263 serves as the Waiver of Supplemental Security Income (SSI) Payment Continuation. The main purpose of this form is to allow SSI recipients to waive their right to have SSI payments continue while their eligibility is being reviewed or appealed. This form provides recipients with the option to discontinue SSI payments during the review process, as they may need to repay any overpaid benefits if their eligibility is not upheld.
Form SSA-2574, the Information About Joint Checking/Savings Accounts Supplemental Security Income, is used to gather information about joint checking or savings accounts that may affect eligibility for Supplemental Security Income (SSI). The primary purpose of this form is to collect details about joint accounts that could impact the calculation of SSI benefits.
Form SSA-2519 is the Child Relationship Statement. The main purpose of this form is to allow individuals to provide detailed information about their relationship to a child who is seeking Social Security benefits, particularly in cases where the child is not the biological child of the applicant.
Form SSA-2512, the Pre-1957 Military Service Federal Benefit Questionnaire, is used to gather information about pre-1957 military service that may affect entitlement to Social Security benefits. The main purpose of this form is to collect information from individuals who served in the military before 1957 and are eligible for special Social Security benefits.
Form SSA-25 serves as the Certification of Election for Reduced Spouse's Benefits. The primary purpose of this form is to allow spouses who are eligible for Social Security benefits based on their own work record and their spouse's work record to certify their election for reduced spouse's benefits. Spouses can choose to claim reduced benefits as early as age 62.
Form SSA-2490, the Application For Benefits Under a U.S. International Social Security Agreement, is used by individuals who have Social Security credits in multiple countries, thanks to international Social Security agreements. The main purpose of this form is to allow individuals to apply for benefits from the U.S. based on these international agreements.
