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.
Form SSA-3885. Government Pension Questionnaire
Form SSA-3885, the Government Pension Questionnaire, is used to collect information about government pensions received by individuals who are claiming Social Security benefits.
Form SSA-3881-BK. Questionnaire for Children Claiming SSI Benefits
Form SSA-3881-BK, the Questionnaire for Children Claiming SSI Benefits, is a questionnaire for parents or guardians of children claiming Supplemental Security Income (SSI) benefits.
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-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-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-546. Worker's Compensation/Public Disability Questionnaire
Form SSA-546, the Worker's Compensation/Public Disability Questionnaire, serves as a tool to gather information regarding a claimant's receipt of workers' compensation or public disability 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-3830. Certification of Low Birth Weight for SSI Eligibility
Form SSA-3830, the Certification of Low Birth Weight for SSI Eligibility, is used to certify the low birth weight of a child for eligibility for Supplemental Security Income (SSI) benefits.
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.