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-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-7008. Request for Correction of Earnings Record
Form SSA-7008 serves as a Request for Correction of Earnings Record. Its main purpose is to allow individuals to request corrections or updates to their Social Security earnings records.
Form SSA-3. Marriage Certification
Form SSA-3 is the Marriage Certification. The main purpose of this form is to document and certify a marriage for Social Security benefit purposes. It is used to establish the legal validity of a marriage when individuals are applying for benefits as a spouse or surviving spouse.
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-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-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-5-BK. Application for Mother's or Father's Insurance Benefits
Form SSA-5-BK, the Application for Mother's or Father's Insurance Benefits, serves as the formal application for individuals to claim insurance benefits based on the work history of their parents.
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).