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Social Security Administration (SSA) Forms in Word
Our SSA forms have gone through a rigorous approval process by the SSA.All
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Form |
Description |
Price |
Buy Now in Word |
| SSA-1695 | Identifying Information for Possible Direct Payment of Authorized Fees (SSA 1695 form) (9-06 version) | $12.99 |
|
| SSA 61 | Request for Review by a Federal Reviewing Official | $12.99 |
|
SSA 3373-BK |
Disability Report Adult - SSA 3373 BK- 10 pages |
$12.99 |
|
SSA 3380-BK |
FUNCTION REPORT - ADULT - THIRD PARTY Form SSA-3380-BK |
$19.00 |
|
SSA-3368-BK |
DISABILITY REPORT—ADULT— Form SSA 3368 BK |
$12.99 |
|
| SSA-3369-BK |
Work History Report - SSA 3369 BI |
$12.99 |
|
SSA-3820-BK |
Disability Report - Child - SSA 3820 BK |
$12.99 |
|
| SSA 16-BK | Application for Disability Insurance Benefits | $39.00 |
|
| SSA 8000-BK (also known as SSA 8001-BK) (formerly 8001-FS) | Application for Supplemental Security Income (10 pages; revised to 12/06 version and approved by SSA) | $12.99 |
|
| SSA 2506-BK | Psychiatric Review Technique (15 pages) SSA 2506 BK | $29.00 |
|
| SSA 4734-BK | Physical Residual Functional Capacity Assessment SSA 4734 BK | $12.99 |
|
SSA 1020 |
Application for Help
with Medicare Prescription Drug Plan Costs, SSA-1020 |
Not in Word; obtain from the SSA at this link. | |
SSA-3 |
Marriage Certification - 2
pages |
$12.99 |
|
SSA-21 |
Supplement to Claim of Person
Outside the
United States
|
$12.99 |
|
| SSA 131 | EMPLOYER REPORT OF SPECIAL WAGE PAYMENTS | $12.99 |
|
SSA 150 |
MODIFIED BENEFIT FORMULA QUESTIONNAIRE |
$12.99 |
|
SSA-308 |
Modified Benefits Formula
Questionnaire, Foreign Pension |
$12.99 |
|
SSA-521 |
Request for Withdrawal of
Application |
$12.99 |
|
SSA-545 |
Plan for Achieving Self-Support |
$12.99 |
|
SSA-546 |
Worker's Compensation/Public
Disability Questionnaire |
$12.99 |
|
SSA 671 |
Railroad Employment Questionnaire |
$12.99 |
|
SSA-723 |
Statement Regarding the Inferred
Death of an Individual |
$12.99 |
|
SSA-781 |
Certificate of Responsibility
for Welfare and Care of Child |
$12.99 |
|
SSA-782 |
Form has been replaced by
form SSA-3441-BK |
$12.99 |
|
SSA 783 |
Statement Regarding Contributions |
$12.99 |
|
SSA 788 |
STATEMENT OF CARE AND RESPONSIBILITY
FOR BENEFICIARY |
$12.99 |
|
SSA-789 |
Request for Reconsideration
- Disability Cessation |
$12.99 |
|
SSA 795 |
STATEMENT OF CLAIMANT OR OTHER
PERSON |
$12.99 |
|
SS-5 |
Application for a Social Security
Card |
$12.99 |
|
SS-5-FS |
Application for a Social Security
Card |
$12.99 |
|
SSA 820 |
Work Activity Report (Self-Employed
Person) 4 pages |
$12.99 |
|
SSA 831 |
Work Activity Report (Employee)
- 8 pages |
$12.99 |
|
SSA-827 |
Authorization to Disclose
Information to SSA |
$12.99 |
|
SSA 1199A |
Direct Deposit Sign-Up Form (SF-1199A) |
$12.99 |
|
1372-BK |
STUDENT'S STATEMENT REGARDING
SCHOOL ATTENDANCE (8 pages) |
$12.99 |
|
SSA 2512 |
Pre-1957 Military Service
- Federal Benefit Questionnaire (2 pages) |
$12.99 |
|
SSA 2519 |
Child Relationship Statement |
$12.99 |
|
SSA-2000 |
Application for Special Benefits
for World War II Veterans |
$12.99 |
|
SSA-1696 |
Appointment of Representative |
$12.99 |
|
| HA-4631, 4632, & 4633 | Combines 4631, 4632, and 4633 into one convenient document! | $27.99 |
|
| HA-4633 | Claiman's Work Bankgroud - SSA 4633 & HA 4633 | $12.99 |
|
HA-4632 |
Claimant's Medications - SSA 4632 & HA 4632 |
$12.99 |
|
SSA 3369 BK |
WORK HISTORY REPORT-Form SSA-3369-BK
(10 pages) |
$12.99 |
|
SSA 3441-BK (SSA3441) |
DISABILITY REPORT - APPEAL
- Form SSA-3441-BK (10 pages) |
$19.50 |
|
HA-4631 |
Claimant's Recent Medical
Treatment - SSA 4631 & HA 4631 |
$12.99 |
|
| SSA 538-F6 | Childhood Disability Evaluation Report (6 pages) | $12.99 |
|
SSA 3820 |
Disability Report - Child
Form SSA-3820-BK (14 pages) |
$12.99 |
|
SSA 3881 |
QUESTIONNAIRE FOR CHILDREN
CLAIMING SSI BENEFITS (8 pages) |
$12.99 |
|
SSA 3885 |
Government Pension Questionnaire |
$12.99 |
|
SSA 4162 |
Child care Dropout Questionnaire
(2 pages) |
$12.99 |
|
HA-4486 |
Form has been replaced by
form SSA-3441-BK |
$12.99 |
|
SSA 4184 |
Self-Employment -
Corporate Officer Questionnaire |
$12.99 |
|
| SSA
5665 |
TEACHER QUESTIONNAIRE (10
pages) |
$12.99 |
|
SSA 5666 |
REQUEST FOR ADMINISTRATIVE
INFORMATION (2 pages) |
$12.99 |
|
SSA 7008 |
REQUEST FOR CORRECTION OF
EARNINGS RECORD (2 pages) |
$12.99 |
|
SSA 7014 |
Partnership Questionnaire |
$12.99 |
|
HA-4633 |
Claimant's Work Background |
$12.99 |
|
SSA 7156 |
Farm Self-Employment Questionnaire |
$12.99 |
|
SSA 7157 |
Farm Arrangement Questionnaire |
$12.99 |
|
SSA 7163 |
QUESTIONNAIRE ABOUT EMPLOYMENT
OR SELF-EMPLOYMENT OUTSIDE THE UNITED STATES (2 pages) |
$12.99 |
|
SSA 7163A |
SUPPLEMENTAL STATEMENT REGARDING
FARMING ACTIVITIES OF PERSON LIVING OUTSIDE THE U.S.A. |
$12.99 |
|
SSA 7050 |
REQUEST FOR SOCIAL SECURITY
EARNINGS INFORMATION (4 pages) |
$12.99 |
|
SSA-3288 |
Consent for Release of Information |
$12.99 |
|
SSA-437 |
Discrimination Complaint |
$12.99 |
|
SSA-131 |
Employer Report of Special
Wage Payments |
$12.99 |
|
HA-539 |
Notice Regarding Substitution
of Party Upon Death |
$12.99 |
|
SSA-1560 |
Petition to Obtain Approval
of a Fee for Representing a Claimant |
$12.99 |
|
SSA-3441-BK |
Disability Report - Appeal |
$12.99 |
|
HA-501 |
Request for Hearing by Administrative
Law Judge |
$12.99 |
|
SSA-561-U2 |
Request for Reconsideration |
$12.99 |
|
HA-520 |
Request for Review of Decision/Order
of ALJ |
$12.99 |
|
SSA-632 |
Request for Waiver of Overpayment
Recovery |
$12.99 |
|
SSA-7004 |
Request for Social Security
Statement |
$12.99 |
|
SSA-7004-SP |
Solicitud de Declaración
de Ganancias |
$12.99 |
|
SS-5-SP |
Solicitud Para una Tarjeta
de Seguro Social |
$12.99 |
|
HA-4608 |
Waiver of Your Right to Personal
Appearance Before an ALJ |
$12.99 |
|
HA-510 |
Waiver of Written Notice of
Hearing |
$12.99 |
|
SSA-783 |
Statement Regarding Contributions |
$12.99 |
|
SSA-788 |
Statement of Care and Responsibility
for Beneficiary |
$12.99 |
|
SSA-795 |
Statement of Claimant or Other
Persons |
$12.99 |
|
SSA-820 |
Work Activity Report (Self-Employed) |
$12.99 |
|
SSA-821 |
Work Activity Report, Employee |
$12.99 |
|
SSA-1372 |
Student's Statement Regarding
School Attendance |
$12.99 |
|
SSA-1724 |
Claim for Amounts Due in Case
of a Deceased Beneficiary |
$12.99 |
|
SSA-2512 |
Pre-1957 Military Service
Federal Benefit Questionnaire |
$12.99 |
|
SSA-2519 |
Child Relationship Statement |
$12.99 |
|
SSA-3820 |
Disability Report, Child |
$12.99 |
|
SSA-3369 |
Work History Report |
$12.99 |
|
SSA-3885 |
Government Pension Questionnaire |
$12.99 |
|
SSA-4162 |
Child Care Dropout Questionnaire |
$12.99 |
|
SSA-4184 |
Self Employment Corporate
Officer Questionnaire |
$12.99 |
|
| SSA-4395 | Application for Access to SSA Headquarters Facilities | $12.99 |
|
SSA-7008 |
Request for Correction of
Earnings Record |
$12.99 |
|
SSA-7050 |
Request for Social Security
Information |
$12.99 |
|
SSA-7104 |
Partnership Questionnaire |
$12.99 |
|
SSA-7156 |
Farm Self Employment Questionnaire |
$12.99 |
|
SSA-7157 |
Farm Arrangement Questionnaire |
$12.99 |
|
SSA-7163 |
Questionnaire About Employment
or Self Employment Outside the
US
|
$12.99 |
|
SSA-7163A |
Statement Regarding Farming
Activities of Persons Living Outside US |
$12.99 |
|
SSA-150 |
Modified Benefits Formula
Questionnaire |
$12.99 |
|
SSA-671 |
Railroad Employment Questionnaire |
$12.99 |
|
SSA 6559 |
Transmitter Report and Summary
of Magnetic Media |
$12.99 |
|
SSA 6559-A |
Continuation Sheet for Form
6559 |
$12.99 |
|
SF-1199A |
Direct Deposit Sign-Up Form |
$12.99 |
|
SSA-5665-BK |
Teacher Questionnaire |
$12.99 |
|
SSA-5666 |
Request for Administrative
Information |
$12.99 |
|
SSA-3881 |
Questionnaire for Children
Claiming SSI Benefits |
$12.99 |
|
| SSA 8001 BK (also known as SSA 8001-BK; was SSA 8001BK-FS) | Application for Suplemental Security Income (new form 12/06) 10 pages & approved by SSA | $59 |
 |
Forms in Word & Wordsworth
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