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  • SSA-3373-BK - Function Report- Adult
    The information that you give us on this form will be used by the office that makes the disability decision on your disability claim You can help them by completing as much of the form as you can
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    About Forms All forms are free If you cannot find the form you need or require assistance completing the form, please go to the Contact Us link Submitting Forms and Supporting Documents You can electronically complete, upload, and submit select forms to Social Security using the Upload Documents feature You can also fax or mail any paper form to your local office, unless otherwise
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    SSA-3369-BK (06-2024) UF SECTION 2 - WORK HISTORY (continued) Provide more information about Job No 1 listed in Section 2 Estimate hours and pay, if needed If you need more space, use section 3
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    Form SSA-3368-BK (06-2024) UF Discontinue Prior Editions Page 1 of 15 Social Security Administration OMB No 0960-0579
  • Form SSA-1724 | Claim For Amounts Due In The Case Of Deceased . . .
    Form SSA-1724 | Claim For Amounts Due In The Case Of Deceased Beneficiary A deceased beneficiary may have been due a Social Security payment and or a Medicare Premium refund prior to or at the time of death
  • SSA-821-BK - Work Activity Report - Employee
    Form SSA-821-BK (09-2025) UF BNC#: 3A Beginning with your most recent employer, please tell us about your work activity since the date shown I am enclosing or have already provided pay stub information (online, by mail, or in the office), or it has already been submitted for me
  • SSA-827 - Authorization to Disclose Information to the Social Security . . .
    Explanation of Form SSA-827, "Authorization to Disclose Information to the Social Security Administration (SSA)" We need your written authorization to help get the information required to process your claim, and to determine your capability of managing benefits
  • Seguro Social Formularios | SSA
    SSA-437-BK-SP Formulario para querellas de derechos civiles de alegaciones por discriminación en los programas de la Administración del Seguro Social Formulario
  • SSA-3380-BK - Function Report- Adult
    FUNCTION REPORT - ADULT - THIRD PARTY Form SSA-3380-BK READ ALL OF THIS INFORMATION BEFORE YOU BEGIN COMPLETING THIS FORM IF YOU NEED HELP If you need help with this form, complete as much of it as you can and call the phone number provided on the letter sent with the form, or contact the person who asked you to complete the form





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