Form SSA-3375-BK. Function Report - Child Birth to 1st Birthday
Form SSA-3375-BK is the Function Report for Children from Birth to 1st Birthday. The primary purpose of this form is to collect information about a child's development and functioning during their first year of life.
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-632-BK. Request for Waiver of Overpayment Recovery
Form SSA-632-BK, issued by the Social Security Administration, is used for the purpose of requesting a waiver of overpayment recovery.
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-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-268. Patient Acknowledgement Form for Influenza Vaccination
Form SSA-268, the Patient Acknowledgment Form for Influenza Vaccination, is used to acknowledge receipt of the influenza vaccine by patients in healthcare facilities.
Form SSA-5665-BK. Teacher Questionnaire
Form SSA-5665-BK, the Teacher Questionnaire, is used to collect information from educators about a student's ability to function independently due to a physical or mental condition.
Form SSA-2855. Statement of Funds you Received
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.
Form SSA-521. Request for Withdrawal of Application
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.
Form SSA-1414. Credit Card Payment Form
Form SSA-1414 serves as a Credit Card Payment Form. The primary purpose of this form is to provide a means for individuals to make payments to the Social Security Administration using a credit card.