Social Security

Social Security Administration Forms - SSA 3368 BK - Disability Report_ Adult

DISABILITY REPORT -ADULT -Form SSA-3368-BK PLEASE READ ALL OF THIS INFORMATION BEFORE YOU BEGIN COMPLETING THIS FORM THIS IS NOT AN APPLICATION IF YOU NEED HELP If you need help with this form, do as much of it as you can, and your interviewer will help you finish it. However, if you have access to the Internet, you may access the Disability Report  ... more>>

Function Report-Adult

SOCIAL SECURITY ADMINISTRATION Form Approved OMB No. 0960-0681 FUNCTION REPORT - ADULT how your illnesses, injuries, or conditions limit your activities For SSA Use Only Do not write in this box. Related SSN Number Holder SECTION A - GENERAL INFORMATION 1. NAME OF DISABLED PERSON (First, Middle, Last) Sandra Allen 2. SOCIAL SECURITY NUMBER xxx-  ... more>>

Social Security Administration Forms -SSA 521- Request for Withdrawal of Application

Other (Please explain fully): Signature (First name, middle initial, last name) (Write in ink) I hereby request the withdrawal of my application, dated as above, for the reasons stated below. I understand that (1) this request may not be cancelled after 60 days from the mailing of notice of approval; and (2) if a determination of my entitlement has  ... more>>

Checklist - Childhood Disability Interview

Checklist - Adult Disability Interview

Medical Authorization

Form Approved OMB No. 0960-0623 WHOSE Records to be Disclosed First NAME Middle Last Confirm SSN is entered SSN NAME SSN Birthday SSA USE ONLY NUMBER HOLDER (If other than above) AUTHORIZATION TO DISCLOSE INFORMATION TO THE SOCIAL SECURITY ADMINISTRATION (SSA) ** PLEASE READ THE ENTIRE FORM, BOTH PAGES, BEFORE SIGNING BELOW ** I voluntarily a  ... more>>

Request for Hearing

SOCIAL SECURITY ADMINISTRATION OFFICE OF HEARINGS AND APPEALS Form Approved OMB No. 0960-0269 REQUEST FOR HEARING BY ADMINISTRATIVE LAW JUDGE (Take or mail the signed original to your local Social Security office, the Veterans Affairs Regional Office in Manila or any U.S. Foreign Service post and keep a copy for your records) 1. CLAIMANT 2. WAGE  ... more>>

SSA-3288 Consent For Release of Information

Form Approved OMB No. 0960-0566 Social Security Administration Consent for Release of Information TO: Social Security Administration Name: John Smith Date of Birth 6/29/1967 Social Security Number 123-45-6789 I authorize the Social Security Administration to release information or records about me to: NAME Assigned CM Sarita McGowan complete ADD  ... more>>