Social Security Administration (SSA)
Forms in Microsoft Word

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Form No.	Form Title	Price	Buy Now in Microsoft Word
SSA-21 Form	Supplement to Claim of Person Outside the United States	$7.50
SSA-44	Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event	$7.50
SSA-54 Form	Authorization for SSA to Disclose Tax Information for Your Appeal of Your Medicare Part B Income-Related Monthly Adjustment Premium Amount	$7.50
SSA-89 Form	Authorization for the Social Security Administration To Release Social Security Number (SSN) Verification	$7.50
SSA 131 Form	EMPLOYER REPORT OF SPECIAL WAGE PAYMENTS	$7.50
SSA 150 Form	MODIFIED BENEFIT FORMULA QUESTIONNAIRE	$7.50
SSA-308 Form	Modified Benefits Formula Questionnaire, Foreign Pension	$7.50
SSA-437	Complaint Form for Allegations of Discrimination in Programs or Activities Conducted by the Social Security Administration	$7.50
SSA HA-501 Form	Request for Hearing by Administrative Law Judge	$7.50
SSA HA-510 Form	Waiver of Written Notice of Hearing	$7.50
SSA HA-520 Form	Request for Review of Decision/Order of ALJ	$7.50
SSA-545 Form	Plan for Achieving Self-Support	$7.50
SSA-546 Form	Worker's Compensation/Public Disability Questionnaire	$7.50
SSA-561-U2 Form	Request for Reconsideration	$7.50
SSA-711 Form	Request for Deceased Individual's Social Security Record	$7.50
SSA-714	You Can Make Your Payment By Credit Card	$7.50
SSA-721 Form	Statement of Death by Funeral Director	$7.50
SSA-753 Form	Statement Regarding Marriage	$7.50
SSA-754 Form	Statement of Marital Relationship	$7.50
SSA 783 Form	Statement Regarding Contributions	$7.50
SSA-789 Form	Request for Reconsideration - Disability Cessation	$7.50
SSA 795 Form	STATEMENT OF CLAIMANT OR OTHER PERSON	$7.50
SSA-827 Form	Authorization to Disclose Information to SSA	$7.50
SSA-1365	State Agency Ticket Assignment Form Ticket To Work and Self Sufficiency Program	$7.50
SSA-1372 Form	Student's Statement Regarding School Attendance	$7.50
SSA-1694	Request for Business Entity Taxpayer Information	$7.50
SSA-1695 Form	Identifying Information for Possible Direct Payment of Authorized Fees	$7.50
SSA-1696 Form	Appointment of Representative	$7.50
SSA-1724 Form	Claim for Amounts Due in Case of a Deceased Beneficiary	$7.50
SSA-1945 Form	Statement Concerning Your Employment In a Job Not Covered by Social Security	$7.50
SSA-3288 Form	Consent for Release of Information	$7.50
SSA-3368-BK	DISABILITY REPORT—ADULT	$24.99
SSA 3441-BK Form	DISABILITY REPORT - APPEAL	$7.50
SSA 3373-BK	Disability Report Adult	$7.50
SSA-3881	Questionnaire for Children Claiming SSI Benefits	$7.50
SSA 3885 Form	Government Pension Questionnaire	$7.50
SSA-4111	Certification of Election for Reduced Widow(er)'s and Surviving Divorced Spouse's Benefits	$7.50
HA-4608	Waiver of Your Right to Personal Appearance Before an Administrative Law Judge	$7.50
SSA HA-4631 Form	Claimant's Recent Medical Treatment	$7.50
SSA HA-4632 Form	Claimant's Medications	$7.50
SSA HA-4633 Form	Claiman's Work Bankgroud	$7.50
SSA HA-4631, 4632, & 4633 Form	Combines 4631, 4632, and 4633 into one convenient document!	$59.00
SSA-7008 Form	Request for Correction of Earnings Record	$7.50
SSA 7050 Form	REQUEST FOR SOCIAL SECURITY EARNINGS INFORMATION	$7.50
SSA-7104 Form	Partnership Questionnaire	$7.50
SSA 7156 Form	Farm Self-Employment Questionnaire	$7.50
SSA-7157 Form	Farm Arrangement Questionnaire	$7.50
SSA 8001 Form	Application for Suplemental Security Income	$59.00

You may obtain all Social Security Forms and assistance to complete the forms, for free, from the Social Security Administration.

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