Form SSA-4111. Certification of Election for Reduced Widow(er)'s and Surviving Divorced Spouse's Benefits
Form SSA-4111, the Certification of Election for Reduced Widow(er)'s and Surviving Divorced Spouse's Benefits, serves as a certification form for individuals who are eligible for widow(er)'s or surviving divorced spouse's benefits but choose to receive a reduced benefit amount.
Form SSA-4162. Child Care Dropout Questionnaire
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.
Form SSA-4178. Marital Relationship Questionaire
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.
Form SSA-437-BK. Complaint Form for Allegations of Discrimination in Programs or Activities Conducted by the Social Security Administration
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).
Form SSA-454-BK. Continuing Disability Review Report
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.
Form SSA-4814. Medical Report on Adult with Allegation of Human Immunodeficiency Virus (HIV) Infection
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.
Form SSA-4815. Medical Report on Child with Allegation of Human Immunodeficiency Virus (HIV) Infection
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.
Form SSA-4-BK. Application for Child's Insurance 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.
Form SSA-4-INST. Reporting Responsibilities for Child's Insurance Benefits
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.
Form SSA-5062. Claimant's Statement about Loan of Food or Shelter
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.