Social Security Administration

SSA

Federal Forms

Forms
OMB NumberTitle
0960-0822 The enhanced Leads and Applications System (eLAS) and iAppointment
0960-0821 Retaining Employment and Talent After Injury/Illness Network (RETAIN) demonstration
0960-0820 Notice to Electronic Information Exchange Partners to Provide Contractor List
0960-0819 Online Request for Correction of Earnings Record
0960-0818 Improving Customer Experience (OMB Circular A-11, Section 280 Implementation
0960-0817 Electronic Consent Based Social Security Number Verification
0960-0816 The Strengthening Protections for Social Security Beneficiaries Act of 2018, Section 103(b) Questionnaire
0960-0815 Ohio Direct Referral Demonstration (ODRD)
0960-0814 Advance Designation of Representative Payee
0960-0813 Removing Inability to Communicate in English as an Education Category
0960-0812 Tribal Council Coverage Agreement
0960-0811 The Department of the Treasury’s Pay.gov Collection Application for Benefit Overpayments
0960-0810 Fee Agreement for Representation before the Social Security Administration
0960-0809 Promoting Opportunity Project (POD)
0960-0808 myWageReport
0960-0807 Authorization for the Social Security Administration to Obtain Wage and Employment Information from Payroll Data Providers
0960-0806 Supported Employment Demonstration (SED) Project
0960-0805 Report of Adult Functioning-Employer
0960-0804 Rules of Conduct and Standards of Responsibility for Appointed Representatives
0960-0803 Evidence From Excluded Medical Sources of Evidence
0960-0802 Data Exchange Request Form
0960-0801 Authorization for the Social Security Administration to Obtain Personal Information
0960-0800 National Beneficiary Survey - NBS General Waves and Semi-Structured Interviews
0960-0799 Promoting Readiness of Minors in SSI (PROMISE) Evaluation - Interviews with Program Staff, and Focus Group Discussions
0960-0798 SSA Health IT Partner Assessment - Participating Facilities and Available Content Form, SSA-680
0960-0797 Automated Scheduling Application (ASA)
0960-0796 Protecting the Public and Our Personnel to Ensure Operational Effectiveness (RIN 0960-AH35), Regulation 3729I
0960-0795 Request for Documents or Information (Form SSA-2118-U2)
0960-0794 Request to Show Cause for Failure to Appear
0960-0793 Homeless with Schizophrenia Presumptive Disability (HSPD) Pilot Demonstration
0960-0792 Incoming and Outgoing Intergovernmental Personnel Act (IPA) Assignment Agreement
0960-0791 Application for Access to SSA Systems
0960-0790 Screen Pop (Automated Telephone Application)
0960-0789 SSA's Public Credentialing and Authentication Process
0960-0788 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (Fast Track)
0960-0786 Statement of Claimant or Other Person-Medical Resident FICA Refund Claims
0960-0785 Benefit Offset National Demonstration (BOND) Project
0960-0784 Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event
0960-0783 Waiver of Supplemental Security Income Payment Continuation
0960-0782 Questionnaire About Special Veterans Benefits
0960-0781 Reissuance of Economic Recovery Payments to Estates
0960-0780 Centenarian Project and Medicare Non-Utilzation Project Development Worksheets: Face-to-Face Interview; Telephone Interview
0960-0779 Important Information About Your Appeal, Waiver Rights and Repayment Options
0960-0778 Notification of a Social Security Number (SSN) to an Employer for Wage Reporting
0960-0777 Request for Accommodation in Communication Method
0960-0776 Financial Disclosure for Civil Monetary Penalty (CMP) Debt
0960-0775 Use of Date of Written Statement As Filing Date (SSA-3431P; RIN 0960-AG58)
0960-0774 Revisions to Rules on Representation of Parties
0960-0773 Medicare Modernization Act Outreach Program
0960-0772 Request for Medical Treatment in an SSA Facility: Self-Administered or Staff Administered Care
0960-0771 Sheltered Workshop Wage Reporting
0960-0770 Social Security Statement Survey
0960-0769 Conducting Personal Conferences When Waiver of Recovery of a Title II or Title XVI Overpayment Cannot be Approved
0960-0768 Protection and Advocacy for Beneficiaries of Social Security (PABSS)
0960-0767 Electronic Records Express Third-Party
0960-0766 Request for Proof(s) from Custodian of Records
0960-0765 Race & Ethnicity Collection System (RECS) Qualitative Research
0960-0764 Amendments to the Administrative Law Judge, Appeals Council, and Decision Review Board Appeals Levels
0960-0763 Application Status
0960-0762 Authorization for SSA to Disclose Tax Information for Your Appeal of Your Medicare Part B Income-Related Monthly Adjustment Premium Amount, 20 CFR 418.1350
0960-0761 Authorization to Release Medical Report to Physician
0960-0760 Consent-Based Social Security Number Verification Service (CBSV)
0960-0759 Certificate of Election for Reduced Widow(er)’s and Surviving Divorced Spouse’s Benefits
0960-0758 Technical Updates to Applicability of the Supplemental Security Income (SSI) Reduced Benefit Rate for Individuals Residing in Medical Treatment Facilities. 20 CFR 416.708(k)
0960-0757 Government to Government Services Online Website Registration, Government to Government Services Online Website Account Modification/Deletion Form
0960-0756 Timely Progress Provisions of the Ticket to Work Regulation
0960-0755 Request to Decision Review Board to Vacate the Administrative law Judge Dismissal of Hearing.
0960-0754 Cost Reimbursable Research Request
0960-0753 Electronic Records Express
0960-0752 Claimant Travel Reimbursement Request
0960-0751 Treating Physician Consultative Examination Interest Form
0960-0750 Fugitive Felon Computer Matching Agreements
0960-0749 Prisoner Matching Agreements
0960-0748 Request for Program Consultation
0960-0747 Accelerated Benefits Demonstration Project
0960-0746 Pilot Program for Participating in Administrative Law Judge Hearings By Using Privately Owned Video Teleconferencing (VTC) Equipment
0960-0745 Attorney and Non-Attorney Representative Fee Payment and Fee Withholding Procedures
0960-0744 Request for Reinstatement (Title XVI)
0960-0743 Methods for Conducting Personal Conferences When Waiver of Recovery of a Title II or Title XVI Overpayment Cannot Be Approved -- 20 CFR 404 506(e)(3), 404.506(f)(8) and 416.557(c)(3)& 416.557 (d)(8)
0960-0742 Request for Reinstatement (Title II)
0960-0741 Medicare Part B Income-Related Monthly Adjustment Amount
0960-0740 Representative Payment Policies and Administrative Procedures for Imposing Penalties for False or Misleading Statements or Withholding of Information
0960-0739 Certificate of Incapacity
0960-0738 SSA Guidance for Use of the Tax Information Authorization Form
0960-0737 Continuing Education Information Collection under Non-Attorney Demonstration Project.
0960-0736 SSA Survey of Online Services Internet Panel
0960-0735 Medicare Part B Income-Related Premium -- Life-Changing Event
0960-0734 Statement of Reclamation Action
0960-0733 Social Security Administration Survey of Ticket To Work Beneficiaries
0960-0732 Registration for Appointed Representative Services and Direct Payment
0960-0731 Request for Business Entity Taxpayer Information
0960-0730 Identifying Information for Possible Direct Payment of Authorized Fees
0960-0729 Authorization for SSA to Obtain Account Records From a Financial Institution and Request for Records (Medicare Part D Subsidy)
0960-0728 Request for Review By A Federal Reviewing Official, 20 CFR 405.1, .120, .210, .215, .220, .225, .230
0960-0727 Final Rules for Helping Blind and Disabled Individuals Achieve Self-Support, 20 CFR 416.110(e), 416.1181, and 416.1226
0960-0726 Mental Health Treatment Study (MHTS)
0960-0725 Section 107 Representative Payee Study
0960-0723 Redetermination of Eligibility for Help with Medicare Prescription Drug Plan Costs
0960-0722 Request for Evidence from Doctor or Hospital
0960-0721 Request for School Records 20 CFR 416.906, 416.913, 416.946, 404 Dubpart P, Appendix 1
0960-0720 Certification of Low Birth Weight for SSI Eligibility
0960-0719 Application to Collect A Fee for Payee Services
0960-0718 Limiting Social Security Number Replacement Cards, 422.103(e), 422.110
0960-0716 General Request for Social Security Records--eFOIA
0960-0715 Monthly SSI Wage Reporting
0960-0712 Denial of Title II Benefits to Fugitive Felons
0960-0711 National Direct Deposit Initiative Enrollment Form
0960-0710 Request to Withdraw a Hearing Request; Request to Withdraw an Appeals Council Request for Review; and Administrative Review Process for Adjudicating Initial Disability Claims
0960-0709 Review of the Disability Hearing Officer's Reconsidered Determination Before it is Issued
0960-0708 Medicare Modernization Act Subsidy Application Mailing Follow-Up Survey
0960-0707 Medicare Subsidy Quality Review
0960-0706 Help America Vote Act (HAVA)
0960-0705 Application for Help with Medicare Prescription Drug Plan Costs (Internet/Intranet Versions)
0960-0704 Homeless Outreach Project and Evaluation (HOPE) Evaluation
0960-0703 Application for Help with Medicare Prescription Drug Plan Costs (Subsidy Change Redeterminations)
0960-0702 Medicare Part D Subsidies
0960-0701 Epidemiological Research Request
0960-0700 State Death Match Collections
0960-0699 Social Security Administration Eligible Non-Attorney Representative
0960-0698 Request for Waiver of Special Veterans Benefits (SVB) Overpayment Recovery or Change in Repayment Rate
0960-0697 Early Intervention Project / Survey of Emloyment Service Providers (New Mexico, Vermont, and Wisconsin)
0960-0696 Application for Help with Medicare Prescription Drug Plan Costs
0960-0695 Appeal of Determination for Help with Medicare Prescription Drug Plan Costs
0960-0694 Incorporation by Reference of Oral Findings of Fact and Rationale in Wholly Favorable Written Decisions
0960-0693 Letter to Custodian of Birth Records
0960-0692 Expanded Cross-Program Recovery Regulations; 20 CFR Part 404 Subpart F & 20 CFR 416 Subpart E
0960-0691 Representative Payee Report (for Organizational Representative Payees)
0960-0690 Reinstatement of Entitlement to Disability Benefits, 20 CFR 404.1592c & .1592d and 416.999a & .99b
0960-0689 Certification of Contents of Document(s) or Record(s)
0960-0688 Certification of Prison Records by Prison Officials
0960-0687 Youth Transition Process Demonstration Evaluation Collection
0960-0686 International Direct Deposit
0960-0685 Filing of Applications and Related Forms; 404.610, .611; 422.505
0960-0684 Evidence Requirements for Assignment of SSNs/Assignment of SSNs to Foreign Academic Students
0960-0683 Special Benefits for Certain World War II Veterans, 20 CFR 408 Subparts G, H, I, J & L
0960-0681 Function Report - Adult
0960-0680 Medical Consultant's Review of Physical Residual Functional Capacity Assessment
0960-0679 Representative Payment Policies Regulation
0960-0678 Medical Consultant's Review of Mental Residual Functional Capacity Assessment
0960-0677 Medical Consultant's Review of Psychiatric Review Technique Form
0960-0676 Annual Earnings Test, 20 CFR 404.428(b), .429(d), .435(d)(e) and .452(a)-(e)
0960-0675 Medical or Psychological Consultant's Review of Childhood Disability Evaluation Form (SSA-538)
0960-0674 Internet Social Security Disability Report - Child
0960-0673 Internet Report of Continuing Disability Interview (i454)
0960-0672 Monthly SSI Wage Reporting Pilot
0960-0671 Acknowledgement of Receipt (Notice of Hearing)
0960-0669 Employee Verification Service 20 CFR, 401.45
0960-0668 Request for Internet Services Representative Payee Report
0960-0667 Filing Claims Under the Federal Tort Claims Act
0960-0666 Ticket to Work Program Evaluation Survey (National Beneficiary Survey)
0960-0665 Report of Deceased Individual's Social Security Record
0960-0664 20 CFR Parts 404.617 and 416.327 - Claimant Identification Pilot Project
0960-0663 Private Printing and Modification of Prescribed Application and Other Forms
0960-0662 Medical Source Statement of Ability to Do Work-Related Activities
0960-0661 Voice Print Proof Concept Study
0960-0660 Social Security Number Verification Services (SSNVS)
0960-0658 20 CFR 408 Subparts B, C, and D
0960-0657 Disability Hearing Officer's Decision-Title XVI Disabled Child Continuing Disability Review, 20 CFR 404.913-.914, 404.917, 416.994a, 416.1413-.1414, 416.1417
0960-0656 Survey of Income and Program Participation (SIPP) for SSA Beneficiaries
0960-0654 20 CFR Parts 404 Subpart P & 416 Subpart 1 404.1512, 404.1545, 404.1560, 416.912, 416.945 & 416.960
0960-0653 Collection of SSI Overpayments from Special Benefits for Certain WWII Veterans, 20 CFR 416.572
0960-0651 SSA/Pay.Gov Data Collection--TEST/(Online Authetication Form)
0960-0650 Internet Social Security Disability Report (ISSDR)
0960-0649 Access to Information Held by Financial Institutions 20 CFR Part 416
0960-0648 Credit Card Payment Form
0960-0646 Teacher Questionnaire; Request for Administrative Information
0960-0644 The Ticket to Work and Self-Sufficiency Program
0960-0643 Statement for Determining Continuing Eligibility for Supplemental Security Income Payment--Adult/Statement for Determining Continuing Eligibility for Supplemental Security Income.....
0960-0642 Listing of Impairments; 404, Subpart P, Appendix 1
0960-0641 State Agency Ticket Assignment Form Ticket to Work and Self Sufficiency Program
0960-0639 Contact with Rep Payee, Contact with Beneficiary
0960-0637 Quiz Show-Internet Edition
0960-0635 Function Report - Adult Third Party
0960-0634 Domestic Direct Deposit Application
0960-0633 Site Review Questionnaires for Volume and Fee-for-Service Payees and Beneficiary Interview Form
0960-0632 Request for Internet Services - Password (RISPA)
0960-0630 Beneficiary Interview and Auditor's Observations
0960-0629 Work Incentives Planning and Assistance (WIPA)
0960-0628 Survey of Low-Income and Disabled Kids (SOLID KIDS)
0960-0627 Employment Support Representative Position (ESR): Survey of Beneficiaries and Community Organizations
0960-0626 Integration Registration Services (IRES) System
0960-0625 Electronic Death Registration Survey
0960-0624 Medical Permit Parking Application
0960-0623 Authorization to Disclose Information to the Social Security Administration
0960-0622 Request for Reconsideration
0960-0621 Representative Payee Report-Special Veterans Benefits
0960-0620 Advance Notice of Termination of Child's Benefits, and Student's Statement Regarding School Attendance
0960-0619 Application for SSA Employee Testimony
0960-0618 Social Security Benefits Application
0960-0617 Prohibition of Payment of SSI Benefits to Fugitive Felons and Parole/Probation Violators
0960-0616 Uniform Administrative Requirements for Grants and Agreements with Institutions of Higher Education, Hospitals and Other Non-profit Organizations
0960-0615 Application for Special Benefits for World War II Veterans
0960-0614 Worker's Compensation Letter; Worker's Compensation Questionnaire
0960-0613 Referral System for Vocational Rehabilitation Providers (RSVP)
0960-0612 Public Understanding Measurement Systems (PUMS) Survey
0960-0611 Social Security Card Fee Survey
0960-0610 State Partnership Initiative Demonstration Project
0960-0609 National Study of Health and Activity (NSHA)
0960-0608 Request for Claimant Conference
0960-0607 Request for Information
0960-0606 Annual Registration Statement Identifying Separated Participants with Deferred Vested Benefits (Schedule SSA)
0960-0605 Organization Profile
0960-0604 Symptoms Report
0960-0603 Function Report - Adult
0960-0602 Authorization to Obtain Earnings Data from the Social Security Administration
0960-0601 Qualified Medicare Beneficiary Demonstration Project
0960-0600 SSA Concise Notice Format Survey
0960-0599 Supplemental Security Income (SSI) Redetermination by Mail
0960-0598 Work Activity Report (Self-Employment)
0960-0597 Manchaca Ruling Compliance Survey
0960-0596 Request for Internet Services-Authentication; 800# Automated Telephone Speech Technology-Authentication
0960-0595 Electronic Benefit Verification Information (BEVE)
0960-0594 Survey of Adults to Determine Public Understanding of Social Security Programs
0960-0592 Telephone Survey of SSA Title II Widow(er) Beneficiaries Over the Age 70
0960-0591 Social Security Non-Applicant, Applicant, and Advisor Surveys
0960-0589 Nursing Home Reporting Requirements Related to Supplemental Security Income Recipients
0960-0588 Payee Interview; Beneficiary Interview; Custodian Interview
0960-0586 Focus Group Testing of Public Understanding of Social Security
0960-0585 Discrimination Complaint Form
0960-0584 Survey of Predecision Interview Nonresponders
0960-0583 Internet Request for Replacement of Form SSA-1099/SSA-1042S
0960-0582 Benefit Continuation Survey
0960-0581 Application of Circuit Court Law
0960-0580 Social Security Tax and Benefits Statement Survey
0960-0579 Disability Report - Adult
0960-0578 Work History Report
0960-0577 Disability Report - Child
0960-0576 Representative Payee Report of Benefits and Dedicated Account
0960-0575 Request to Resolve Questionable Quarters of Coverage (QC); Request for QC History Based on Relationship
0960-0574 Medical History and Disability Report (Disabled Child)
0960-0573 Disability Report
0960-0572 Vocational Report
0960-0570 Telephone Replacement Card Test Pilot
0960-0569 Personal Earnings and Benefits Estimate Statement (PEBES), Internet Identity Evaluation
0960-0568 Childhood Disability Evaluation Form
0960-0567 Consent for Release of Information
0960-0566 Privacy and Disclosure of Official Records and Information; Availability of Information and Records to the Public
0960-0565 Employer Report of Special Wage Payments
0960-0564 Quickstart Automated Enrollment System 31 CFR 210
0960-0563 Notice of Interim Assistance Reimbursement
0960-0562 Survey of Employers Regarding a Satellite Broadcast
0960-0561 Modified Benefit Formula Questionnaire-Foreign Pension
0960-0560 Videoconference Evaluation Recontact Survey
0960-0559 Plan to Achieve Self-Support (PASS)
0960-0558 Follow-up Survey for the Project Network Evaluation
0960-0557 Inquiry to File an SSI Child's Application; 20 CFR 416.345
0960-0556 Annual Registration Statement Identifying Separated Participants
0960-0555 Disability Case Development Information Collections
0960-0554 Certificate of Coverage Request
0960-0553 Payment Cycling Impact Survey
0960-0552 Work History Report
0960-0551 Measuring Public Perception of the Value of Social Security
0960-0550 SSI PE RETURNED CHECK QUESTIONNAIRE
0960-0549 Request to Have Supplemental Security Income Overpayment Withheld from My Social Security Benefits
0960-0548 Drug Addiction and Alcoholism Referral and Monitoring Agency Treatment Requirements Acknowledgement, Drug Addiction and Alcoholism Referral Monitoring Agency Assessment/Referral and...
0960-0547 Wage Reports and Pension Information
0960-0546 SSI Notice of Interim Assistance Reimbursement (IAR)
0960-0544 Public Information Campaign
0960-0543 Work Incapacity and Reintegration Study
0960-0542 Function Report - Child (Birth to 1st Birthday, Age 1 to 3rd Birthday, Age 3 to 6th Birthday, Age 6 to 12th Birthday, Age 12 to 18th Birthday)
0960-0541 SUPPLEMENTAL SECURITY INCOME REPLY FORM
0960-0540 Pain Report - Child
0960-0539 Report of Function, Adult
0960-0538 STUDY PLANS FOR ACHIEVING SELF SUPPORT
0960-0536 Beneficiary Recontact Report
0960-0535 RACE/ETHNIC QUESTIONNAIRE, CUSTOMER OPINION SURVEY
0960-0534 Waiver of Right to Appear--Disability Hearing
0960-0533 Waiver of Benefit Payment
0960-0531 Social Security Request for Information
0960-0530 ANNUAL EARNINGS STUFFER QUESTIONNAIRE
0960-0529 Claimant Statement About Loan of Food or Shelter; Statement about Food or Shelter Provided to Another
0960-0528 STUDY ON THE USE OF THE SSA-4122
0960-0527 Appointment of Representative
0960-0526 Generic Clearance of Customer Satisfaction Surveys
0960-0525 Request for Social Security Earnings Information
0960-0524 FOCUS GROUP TESTING OF SSA'S SERVICE DELIVERY AND REENGINEERING OF THE DISABILITY PROCESS
0960-0523 PERIODIC WAGE REPORT (MONTHLY), SSA-425 PERIODIC WAGE REPORT (BIMONTHLY), SSA-426 PERIODIC WAGE REPORT (QUARTERLY), SSA-427
0960-0522 FINAL REGULATION CONCERNING THE COAL ACT OF 1992
0960-0521 Customer Satisfaction Survey Questionnaires
0960-0520 800 NUMBER AFTERHOURS CALLER SURVEY
0960-0519 SSI PRERELEASE SURVEY QUESTIONNAIRE
0960-0518 SUPPLEMENTAL SECURITY INCOME NO CHANGE REDETERMINATION STUDY
0960-0517 State Report of Incorrect Bendex Information
0960-0516 Continuation of Supplemental Security Income Payments for the Temporarily Institutionalized – Certification of Period and Need to Maintain Home
0960-0515 ENUMERATION IDENTIFY REVIEW DATA COLLECTION FORM
0960-0514 QUESTIONNAIRE TO DETERMINE THE STATUS OF AUTOMATION IN THE STATE DDSS
0960-0513 GRADUATING TO INDEPENDENCE EVALUATION FORMS
0960-0512 QUESTIONNAIRE ON STATUS OF DDS AUTOMATION (CONCEPT CLEARANCE)
0960-0511 Disability Update Report
0960-0510 PROJECT NETWORK BASELINE SURVEY
0960-0509 RECEIPT DEMONSTRATION PROJECT -- CALLER RECONTACT SURVEY
0960-0508 SSA-L2765, Request for Self-Employment Information, SSA-L3365, Request for Employee Information, SSA-L4002, Request for Employer Information
0960-0507 Disability Hearing Officer's Report of Disability Hearing (DC)
0960-0506 NATIONAL SURVEY OF DISABILITY APPLICANTS
0960-0505 Employer Verification of Records for Children Under Age 7
0960-0504 Disablity Report, Child
0960-0503 MEDICAL REPORT ON ADULT/CHILD WITH ALLEGATION OF HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION
0960-0502 Beneficiary Recontact Report
0960-0501 Blood Donor Locator Service (BDLS)
0960-0500 Medical Report with Allegation of Human Immunodeficiency Virus (HIV) Infection--Adult and Child
0960-0499 Questionnaire for Children Claiming SSI Benefits
0960-0498 COMPENSATION FOR QUALIFIED ORGANIZATIONS SERVING AS REPRESENTATIVE PAYEE
0960-0496 UNSUCCESSFUL CALLERS TO THE 800 NUMBER
0960-0495 DIRECT DEPOSIT QUESTIONNAIRE
0960-0494 SSI APPLICANT SURVEY
0960-0493 REPRESENTATIVE PAYEE QUESTIONNAIRE (INDIVIDUAL) AND REPRESENTATIVE PAYEE QUESTIONNAIRE (INSTITUTION)
0960-0492 Request for Supplemental Security Income Benefit Estimate
0960-0491 SERVICE DELIVERY QUESTIONNAIRES (INITIAL AWARDS, REDETERMINATIONS)
0960-0490 SSI OUTREACH QUESTIONNAIRE
0960-0489 VOCATIONAL REPORT - VOCATIONAL REPORT - SUPPLEMENT
0960-0488 QUESTIONNAIRES FOR TEST 5 OF THE PERSONAL EARNINGS AND BENEFIT ESTIMATE STATEMENT PROJECT
0960-0487 Self-Employment/Corporate Officer Questionnaire
0960-0486 DIRECT DEPOSIT COST-OF-LIVING NOTICE TELEPHONE QUESTIONNAIRE
0960-0484 SSA-INITIATED PERSONAL EARNINGS AND BENEFIT ESTIMATE STATEMENT, PUBLIC OPINION QUESTIONNAIRE (FOLLOWUP)
0960-0483 Employee Work Activity Questionnaire
0960-0482 PEBES 800 SERVICE EVALUATION CALLER RECONTACT GUIDE
0960-0481 Statement of Funds You Provided to Another, Statement of Funds You Received
0960-0480 ENUMERATION INTERVIEW GUIDE
0960-0479 PAIN ASSESSMENT INSTRUMENTS DEVELOPMENT REFERRAL FORM - CSPI, CSPI-SO, PSPI-TP, PSPI-CP, FCE, FAME AND FOLLOW-UP
0960-0478 NEW BENEFICIARY FOLLOWUP SURVEY
0960-0477 Modified Benefit Formula Questionnaire-Employer
0960-0476 SSA-INITIATED PERSONAL EARNINGS AND BENEFIT ESTIMATE STATEMENT QUESTIONNAIRIES
0960-0475 SSA Automated SML Application
0960-0474 Child-Care Dropout Questionnaire
0960-0473 Employee Identification Statement
0960-0472 Employer Verification of Earnings After Death
0960-0471 Real Property Current Market Value Estimate
0960-0470 Agency/Employer Government Pension Offset Questionnaire
0960-0469 MEDICAL COST DATA
0960-0468 PERSONNEL COSTS
0960-0467 PROCESSED WORKLOADS
0960-0466 Request for Social Security Statement
0960-0465 800 SERVICE EVALUATION, CALLER RECONTACT SURVEY NO. 1, CALLER TALKED TO A TSR, 800 SERVICE EVALUATION, CALLER RECONTACT SURVEY NO. 2, CALLER USED AUTOMATED MESSAGE....
0960-0464 TRANSITIONAL EMPLOYMENT REINTERVIEW PROJECT
0960-0463 DISABILITY RETURN TO WORK MAILER
0960-0462 You Can Make Your Payment by Credit Card
0960-0461 Information about Joint Checking/Savings Account
0960-0460 Marital Relationship Questionnaire
0960-0458 ACTIVITIES OF DAILY LIVING AND SOCIALIZATION
0960-0457 DISABILITY REPORT AND VOCATIONAL REPORT
0960-0456 Statement of Household Expenses and Contributions
0960-0455 FIELD OFFICE POSTADJUDICATIVE STUDY BENEFICIARY CONTACTS
0960-0454 Letter to Landlord Requesting Rental Information
0960-0452 FIELD TEST OF REVISED SOCIAL SECURITY ADMINISTRATION NOTICES
0960-0451 Permanent Residence in the United States Under Color of Law (PRUCOL)
0960-0450 REQUEST FOR STATEMENT OF EARNINGS - TEST AND EVALUATION
0960-0449 EARNINGS STATEMENT INTERVIEW GUIDE
0960-0448 Application for Benefits Under a U.S. International Social Security Agreement
0960-0446 NPRM-INFORMATION COLLECTION REQUIREMENTS CONTAINED IN REGULATIONS 45 CFR PART 96 (LIHEAP BLOCK GRANT PROGRAMS)
0960-0445 Application for Benefits Under the Italy-U.S. International Social Security Agreements
0960-0444 Application for Supplemental Security Income
0960-0443 Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title XVI
0960-0442 Cessation or Continuance of Disability or Blindness Determination and Transmittal
0960-0441 Disability Hearing Officer's Decision 20 CFR Sections 404.917 and 416.1417
0960-0440 Disability Hearing Officer's Report of Disability Hearing
0960-0438 EXPLANATION OF DETERMINATION
0960-0437 Disability Determination and Transmittal 20 CFR 404.1615(e) and 416.1015(f)
0960-0434 Travel Expense Reimbursement
0960-0433 FINAL RULE - STATE INCOME AND ELIGIBILITY VERIFICATION SYSTEM
0960-0432 Missing and Discrepant Wage Reports Letter and Questionnaire
0960-0431 Physical Residual Functional Capacity Assessment/Mental Residual Capacity Assessment
0960-0430 Summary of Evidence
0960-0429 Notification of Projected Completion Date
0960-0428 Subpoena-Disability Hearing
0960-0427 TIME REPORT OF PERSONNEL SERVICES FOR DISABILITY HEARINGS UNIT
0960-0425 Coverage of Employees of State and Local Governments
0960-0422 BUDGET SUMMARY AND CERTIFICATION
0960-0421 State Agency Report of Obligations for SSA Disability Programs and Addendum; Time Report of Personnel Services for Disability Determination Services; Schedule of Equipment Purchased for SSA
0960-0420 FINAL REGULATIONS ON MEDICAL SUPPORT ENFORCEMENT
0960-0418 RECORDKEEPING FOR THE REFUGEE PROGRAM AND REPORTING REQUIREMENTS
0960-0416 Statement for Determining Continuing Eligibility for Supplemental Security Income Payments
0960-0415 ACKNOWLEDGMENT OF OFFER OF INTERVIEW
0960-0414 RSI HEALTH INSURANCE INFORMATION REQUEST
0960-0413 Psychiatric Review Technique - 20 CFR 404.1520(a), 20 CFR 416.920(a)
0960-0412 ELECTRONIC WAGE REPORTING QUESTIONNAIRE
0960-0411 SURVEY OF ABSENT PARENTS
0960-0410 OFFICE OF CHILD SUPPORT ENFORCEMENT FINANCIAL/STATISTICAL REPORT
0960-0409 1985 SSI SURVEY ON CONTINUING MEDICAID ELIGIBILITY FOR SELECTED GROUPS OF RECIPIENTS
0960-0408 Time Report of Personnel Services for Disability Determination
0960-0406 State Agency Schedule for Equipment Purchases for SSA
0960-0405 NATIONAL REFERENCE CENTER USER SURVEY
0960-0404 STATE AGENCY BUDGET LIST OF FULL-TIME POSITIONS FOR SSA DISABILITY PROGRAMS
0960-0403 STATE AGENCY BUDGET LIST OF PART-TIME AND TEMPORARY POSITIONS FOR DISABILITY PROGRAMS
0960-0402 INFORMATION COLLECTION REQUIREMENTS CONTAINED IN THE REGULATION ON SERVICES TO NON-AFDC INDIVIDUALS AND RELATED STATE PLAN AMENDMENT, 45 CFR 302
0960-0401 TAXATION OF BENEFITS QUESTIONNAIRE
0960-0400 CLAIMS MODERNIZATION PROJECT INTEGRITY REVIEW
0960-0398 Certification of Elections for Reduced Spouse's Benefits
0960-0396 ENUMERATION VALIDATION STUDY INTERVIEW GUIDE
0960-0395 Modified Benefit Formula Questionnaire
0960-0394 45 CFR 303.10(B)(1) OF THE FINAL RULE ON PROCEDURES FOR CASE ASSESSMENT AND PRIORITIZATION
0960-0393 SSA CONTRACTOR REPORT FORMS
0960-0392 WINTER 1984-1985 PRIVATE SECTOR ENERGY ASSISTANCE TELEPHONE SURVEY
0960-0391 MISSING AND DISCREPANT WAGE REPORTS STUDY QUESTIONNAIRES
0960-0390 COST-EFFECTIVENESS OF USING CREDIT REPORTS IN DETERMINING ELIGIBILITY AND PAYMENT FOR USE IN THE AID TO FAMILIES WITH DEPENDENT CHILDREN PROGRAM
0960-0389 1986 SURVEY OF AGED OR DISABLED INDIVIDUALS
0960-0388 REPORT ON AFDC ASSISTANCE UNITS RECEIVING EXCLUDABLE SUPPORT AND MAINTENANCE ASSISTANCE AND HOME ENERGY ASSISTANCE
0960-0387 TRANSITIONAL EMPLOYMENT TRAINING DEMONSTRATION DATA
0960-0386 ANNUAL EARNINGS TEST DIRECT MAIL FOLLOWUP PROGRAM EVALUATION QUESTIONNAIRE
0960-0385 FINAL REG. - INFORMATION COLLECTION REQUIREMENTS CONTAINED IN REGS. THAT IMPLEMENT THE MAJORITY OF THE PROVISIONS OF THE CHILD SUPPORT ENFORCEMENT AMENDMENTS OF 1984
0960-0384 SSA/DDS Cost-Effectiveness Measurement System (CEMS) Data Reporting form
0960-0383 MEDIC DATA COLLECTION FORM
0960-0382 SSI OUTREACH MAIL SURVEY
0960-0381 REPRESENTATIVE PAYEE CUSTODY REPORT
0960-0380 FOREIGN VALIDATION STUDY REPORT
0960-0376 PRIVATE SECTOR ENERGY ASSISTANCE SURVEY
0960-0375 WAGE AND TAX STATEMENT -- W-2 TRANSMITTAL OF INCOME AND TAX STATEMENTS - W-3
0960-0374 SYSTEM STATUS REPORT
0960-0373 QUARTERLY STATEMENT OF FAMIS EXPENDITURES (FAMILY ASSISTANCE MANAGEMENT INFORMATION SYSTEM)
0960-0372 DECLARATION OF CITIZENSHIP BY SOCIAL SECURITY BENEFICIARY OUTSIDE THE UNITED STATES
0960-0371 Application for U.S. Benefits Under the Canada-U.S. International Social Security Agreement
0960-0370 QUARTERLY CONSULTATIONS ON REFUGEE PLACEMENT
0960-0369 Annual Earnings Test Direct Mail Follow-up Program Notices
0960-0368 STATEMENT BY BLACK LUNG BENEFICIARY REGARDING REPORTABLE EVENTS
0960-0367 REPORT TO SOCIAL SECURITY ADMINISTRATION ABOUT WORKERS' COMPENSATION
0960-0366 INTENSIVE CASE MANAGEMENT FOR DRUG ADDICTS AND ALCOHOLICS (SSI) (RESIDENTIAL/NONRESIDENTIAL QUESTIONNAIRE)
0960-0365 1986 CPS - SURVEY OF CHILD SUPPORT AND ALIMONY
0960-0363 INFORMATION EXCHANGE BETWEEN STATE IV-D AND STATE MEDICAID AGENCIES -- NPRM
0960-0361 STATEMENT FOR DETERMINING CONTINUING ELIGIBILITY FOR SUPPLEMENTAL SECURITY INCOME PAYMENTS SSA-8203
0960-0360 RECORDKEEPING FOR THE REFUGEE PROGRAM
0960-0359 PROGRAM REPORTING FOR MAA INCENTIVE GRANTS
0960-0358 INFORMATION ABOUT AMERICANS MISSING IN SOUTHEAST ASIA
0960-0357 REQUEST FOR A CERTIFICATE OF COVERAGE
0960-0356 APPLICATION FOR BENEFITS UNDER THE NORWAY - U.S. INTERNATIONAL SOCIAL SECURITY AGREEMENT
0960-0355 APPLICATION FOR BENEFITS UNDER THE BELGIUM - U.S. INTERNATIONAL SOCIAL SECURITY AGREEMENT
0960-0354 BENEFICIARY RECONTACT REPORT
0960-0352 WAIVER OF RIGHT TO APPEAR - DISABILITY HEARING
0960-0351 Notice Regarding Substitution of Party Upon Death of Claimant Reconsideration of Disability Cessation
0960-0350 Reconsideration Report for Disability Cessation
0960-0349 Request for Reconsideration--Disability Cessation
0960-0348 Request for Change in Time/Place of Disability Hearing
0960-0347 Response to Notice of Revised Determination
0960-0346 HEALTH AND EMPLOYMENT SURVEY
0960-0344 MAINTENANCE OF INFORMATION REQUIREMENTS FOR A COMPUTERIZED CHILD SUPPORT ENFORCEMENT SYSTEM
0960-0343 ADVANCE PLANNING DOCUMENT FOR A COMPUTERIZED CHILD SUPPORT ENFORCEMENT SYSTEM
0960-0341 Request for Address Information: from Motor Vehicles Records; from Employment Commissions Records
0960-0340 THIRD PARTY QUERY INPUT CARD
0960-0339 REFUGEE ASSISTANCE-BY-NATIONALITY REPORT
0960-0338 DECLARATION OF CITIZENSHIP BY SOCIAL SECURITY BENEFICIARY OUTSIDE THE UNITED STATES
0960-0336 REFUGEE STATE-OF-ORIGIN REPORT
0960-0335 STATEMENT OF LIVING ARRANGEMENTS, IN-KIND SUPPORT AND MAINTENANCE
0960-0334 REPORTING REQUIREMENTS FOR TARGETED ASSISTANCE GRANTS FOR SERVICES FOR REFUGEES AND ENTRANTS IN LOCAL AREAS OF HIGH NEED
0960-0333 REGULATIONS TITLE 45, PART 201 - REGULATIONS REGARDING ADJUSTMENT OF FEDERAL SHARE FOR UNCASHED OR CANCELLED CHECKS
0960-0332 WAIVER STUDY - FIELD REVIEW WORKSHEET
0960-0331 REFERRAL AND TREATMENT STATUS OF SSI DRUG ADDICTS OR ALCOHOLICS
0960-0330 JULY 1986 GRANTEE SURVEY OF LOW-INCOME ENERGY ASSISTANCE PROGRAM
0960-0329 SSI MAIL SCREENER SURVEY PRETEST
0960-0327 REQUEST FOR HEARING HOSPITAL INSURANCE BENEFITS PAYABLE UNDER PART A OF TITLE XVIII
0960-0326 EVALUATION OF 1981 AFDC AMENDMENTS--FOLLOWUP TELEPHONE INTERVIEW
0960-0325 QUARTERLY REPORT OF RECOVERIES OF OVERPAYMENTS (AID TO FAMILIES WITH DEPENDENT CHILDREN)
0960-0324 Supplemental Security Income Claim Information Notice
0960-0323 Third Party Liability Information Statement
0960-0322 REPORT OF BLACK LUNG STUDENT BENEFICIARY AT END OF SCHOOL YEAR
0960-0321 STATE'S REPORT OF WAGES PAID
0960-0319 EMPLOYMENT SEARCH PROGRAM--TAX EQUITY AND FISCAL RESPONSIBILIT ACT OF 1982
0960-0318 ESTIMATE OF MONTHLY OBLIGATIONS
0960-0317 QUARTERLY PERFORMANCE REPORT
0960-0316 Claimant's Statement When Request for Hearing is Filed and the Issue is Disability
0960-0315 QUALITY REVIEW QUESTIONNAIRE--DISABILITY
0960-0314 Black Lung Student's Statement Regarding Resumption of School Attendance; Report of Black Lung Student Beneficiary at End of School Year
0960-0313 INTEGRATED REVIEW SCHEDULE
0960-0311 SUMMER STATE SURVEY OF FY 82 LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM
0960-0310 Vocational Rehabilitation Provider Claim
0960-0309 REFUGEE AND ENTRANT UNACCOMPANIED MINOR PLACEMENT REPORT AND REFUGEE AND ENTRANT UNACCOMPANIED MINOR PROGRESS REPORT
0960-0308 ANNUAL SURVEY OF REFUGEES
0960-0307 FEDERAL ANNUAL MAGNETIC TAPE REPORTING REQUEST FOR AUTHORIZATION
0960-0305 CALCULATION OF 1978 BASE YEAR COURT COSTS
0960-0304 20 CFR 416, SUBPARTS K AND L - INCOME AND RESOURCES DEEMING RULES, SUPPLEMENTAL SECURITY INCOME
0960-0301 QUARTERLY ESTIMATE OF EXPENDITURES
0960-0300 Claimant's Work Background
0960-0299 RECIPIENT FRAUD IN PUBLIC ASSISTANCE PROGRAMS
0960-0298 STATE ESTIMATE FORM
0960-0297 DIRECT DEPOSIT MASS CHANGE LISTING
0960-0296 STATEMENT FOR DETERMINING CONTINUING ELIGIBILITY FOR SUPPLEMENTAL SECURITY INCOME PAYMENTS
0960-0295 SOUTHEAST ASIAN REFUGEE SELF-SUFFICIENCY STUDY
0960-0294 QUARTERLY STATEMENT OF EXPENDITURES
0960-0293 Authorization for SSA to Obtain Account Records From A Financial Institution And Request For Records
0960-0292 Claimant's Recent Medical Treatment
0960-0291 STATE PROFILE SHEET - STATE SUPPLEMENTATION PROGRAMS FOR THE AGED, BLIND AND DISABLED
0960-0290 RADIO PROGRAM EVALUATION STUDY
0960-0289 Claimant's Medications
0960-0288 Notice Regarding Substitution of Party Upon Death of Claimant
0960-0287 NEW BENEFICIARY SURVEY
0960-0286 STUDY OF THE MATCHING GRANT PROGRAM FOR REFUGEE RESETTLEMENT
0960-0285 SURVEY OF REFUGEES CONCERNING THE OUTCOMES OF ENGLISH LANGUAGE TRAINING
0960-0284 Waiver of Your Right to Personal Appearance Before a Judge
0960-0283 WINTER STATE SURVEY OF FY 82 LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM
0960-0282 Development of Participation in a Vocational Rehabilitation or Similar Program
0960-0281 APPLICATION FOR THE COLLECTION OF DELINQUENT CHILD SUPPORT PAYMENTS BY THE INTERNAL REVENUE SERVICE
0960-0280 ACKNOWLEDGEMENT OF NOTICE OF HEARING
0960-0279 CORRECTIVE ACTION PLANS AND PROGRESS REPORTS
0960-0278 FINANCIAL STATUS AND PERFORMANCE REPORT FORMS FOR TRANSITION PROGRAM FOR REFUGEE CHILDREN AND EDUCATIONAL SERVICES FOR CUBAN AND HAITIAN ENTRANT CHILDREN
0960-0277 Request for Review of Hearing Decision/Order
0960-0276 REQUEST FOR FUNDS FOR THE WORK INCENTIVE DEMONSTRATION PROGRAM
0960-0275 FINANCIAL STATUS REPORT
0960-0274 Report of Student Beneficiary About to Attain Age 19
0960-0273 STUDY OF THE EXTENT AND EFFECTS OF ENGLISH LANGUAGE TRAINING FOR REFUGEES
0960-0272 APRIL 1982 CURRENT POPULATION SURVEY (CPS), ALIMONY AND CHILD SUPPORT SUPPLEMENT
0960-0271 RECONCILIATION STATEMENT
0960-0270 QUALITY REVIEW QUESTIONNAIRE - RECONTACT OF WIDOWED MOTHER AND FATHER BENEFICIARIES REGARDING REPORTABLE EVENTS
0960-0269 Request for Hearing By Administrative Law Judge
0960-0267 Medicaid Use Report
0960-0266 STATE PLANS FOR REFUGEE RESETTLEMENT
0960-0264 QUALITY REVIEW QUESTIONNAIRE - DISABILITY
0960-0263 SS-5 REDEVELOPMENT STUDY
0960-0262 Employer Classification Update
0960-0261 ANNUAL REPORT BY GRANTEES OF THE NUMBER AND INCOME LEVELS OF HOUSEHOLDS ASSISTED BY LOW INCOME HOME ENERGY ASSISTANCE PROGRAM
0960-0260 AFDC MONTHLY REPORTING
0960-0259 QUALITY REVIEW QUESTIONNAIRE - DISABILITY
0960-0258 PARENT LOCATOR REQUEST (PARENTAL KIDNAPPING)
0960-0256 COMMUNITY WORK EXPERIENCE FINANCIAL RECORDS
0960-0255 WORK INCENTIVE DEMONSTRATION APPLICATION
0960-0254 QUARTERLY WORK INCENTIVE DEMONSTRATION PROGRAM REPORT WIN DEMONSTRATION DATA VALIDATION EMPLOYER/EMPLOYEE QUEST. WIN DEMONSTR. DATA VALIDAT. STATE/LOCAL OFFICE STAFF QUEST.
0960-0253 STATE PLAN FOR CHILD SUPPORT COLLECTION AND ESTABLISHMENT OF PATERNITY UNDER TITLE IV-D OF THE SOCIAL SECURITY ACT
0960-0252 STREAMLINED STATE PLAN FOR AFDC AS AMENDED BY FINAL REGULATIONS ON DISREGARD OF SUPPORT AND MAINTENANCE ASSISTANCE BASED ON NEED
0960-0251 ANNUAL STATISTICAL REPORT ON REQUESTS FOR HEARINGS
0960-0250 STATE ESTIMATE FORM
0960-0249 FINANCIAL STATUS REPORT
0960-0248 CHEP - CUBAN/HAITIAN ENTRANT UNACCOMPANIED MINOR PLACEMENT REPORT
0960-0247 Workers' Compensation/Public Disability Benefit Questionnaire
0960-0244 QUALITY REVIEW QUESTIONNAIRE--DISABILITY QUALITY REVIEW QUESTIONNAIRE--INSURED INDIVIDUAL
0960-0243 NOTICE REQUESTING EMPLOYER IDENTIFICATION NUMBER AND NAME OF ENTITY
0960-0242 STATEMENT CONCERNING BANKING AND BUSINESS TRANSACTIONS
0960-0240 State Supplementation Provisions: Agreements; Payments
0960-0239 QUARTERLY APPLICATION FOR GRANT AWARD
0960-0238 QUARTERLY REPORT OF COLLECTIONS
0960-0237 STATE RECORDKEEPING REQUIREMENTS FOR REFUGEE SERVICES
0960-0236 STATE REFUGEE ASSISTANCE PERFORMANCE AND FINANCIAL STATUS REPORT
0960-0235 QUARTERLY REPORT OF EXPENDITURES AND PRIOR QUARTER EXPENDITURES ADJUSTMENT
0960-0234 STUDENT FIELD REVIW QUESTIONNAIRE AND SCHOOL FIELD CONTACT QUESTIONNAIRE
0960-0231 CUBAN/HAITIAN ENTRANT SPONSORSHIP BREAKDOWN SURVEY
0960-0229 Application for Supplemental Security Income (SSI)
0960-0226 SEMI-ANNUAL BUDGET ESTIMATES
0960-0225 STATE AGENCY STATEMENT OF FINANCIAL PLAN FOR AID TO FAMILIES WITH DEPENDENT CHILDREN
0960-0223 SUMMARY REPORT ON THE LOW INCOME ENERGY ASSISTANCE PROGRAM
0960-0222 CUBAN/HAITIAN ENTRANT STATE ESTIMATE FORM
0960-0221 SF-269-FIN. STATUS REPORT. SF 270-REQUEST FOR ADVANCE OR REIMBURSEMENT
0960-0217 SUPPLEMENTAL SECURITY INCOME-QUALITY ASSURANCE CASE REVIEW ANALYSIS
0960-0216 QUALITY REVIEW QUESTIONNAIRE-DISABILITY: INSURED INDIVIDUAL, SPOUSE AND SURVIVING SPOUSE, AND CHILDREN
0960-0215 DIVISION OF PROGRAM EVALUATION AND MEASUREMENT QUESTIONNAIRE RSDI
0960-0214 STATE PLAN PREPRINTS FOR HOME ENERGY ASSISTANCE PROGRAM-- FY 1981
0960-0213 STUDY OF UNREPORTED BANK ACCOUNTS
0960-0212 APPLICATION FOR SUPPLEMENTAL SECURITY INCOME
0960-0208 1979 RECIPIENT CHARACTERISTICS STUDY ACCURACY CHECK SCHEDULE
0960-0207 REPORT TO SOCIAL SECURITY ADMINISTRATION ABOUT WORKMEN'S COMPENSATION
0960-0196 1978 SURVEY OF WIDOWS WITHOUT BENEFITS
0960-0194 SURVEY OF DISABLED CHILDREN RECEIVING SUPPLEMENTAL SECURITY INSURANCE BENEFITS
0960-0191 NURSING HOME REPORT ON USE OF SOCIAL SECURITY BENEFITS
0960-0190 QUARTERLY ESTIMATE OF EXPENDITURES AND ALLOTMENT NEED
0960-0189 Quality Review Case Analysis: Sample Number Holder; Auxiliaries/Survivors; Parent; Stewardship Annual Earnings Test Workbook
0960-0188 APPLICATION FOR BENEFITS UNDER THE SWITZERLAND-U.S. INTERNATIONAL SOCIAL SECURITY AGREEMENT
0960-0187 PHYSICIAN'S STATEMENT
0960-0186 FINANCIAL STATUS REPORT
0960-0185 ENERGY ASISTANCE FOR LOW INCOME FAMILIES
0960-0184 Instructions for Completion of Federal Assistance Application for SSA Research and Demonstration Grant Programs
0960-0181 BENEFICIARY REMARRIAGE REPORT
0960-0180 REPORT OF NEW INFORMATION FOR BENEFICIARIES WHO HAVE A REPRESENTATIVE PAYEE (GROUP PAYEE SITUATIONS)
0960-0177 REPORT ON CLAIMS OF GOOD CAUSE FOR REFUSING TO COOPERATE IN ESTABLISHING PATERNITY AND SECURING CHILD SUPPORT AND CASE REPORT
0960-0176 WORKSEET FOR INTEGRATED AFDC, FOOD STAMPS AND MEDICAID QUALITY CONTROL REVIEWS
0960-0175 APPLICATION FOR BENEFITS UNDER THE FEDERAL REPUBLIC OF GERMANY-U.S. INTERNATIONAL SOCIAL SECURITY AGREEMENT
0960-0174 Statement of Living Arrangements, In-Kind Support and Maintenance
0960-0172 APPLICATION FOR CERTIFICATE OF COVERAGE
0960-0171 ELECTION OF COVERAGE
0960-0165 REQUEST FOR PARENT LOCATOR SERVICES
0960-0164 ANNUAL STATISTICAL REPORT ON HEARINGS
0960-0163 SIXTH AND SEVENTH WAVE SURVEY-INDOCHINESE RESETTLEMENT OPERATIONAL FEEDBACK
0960-0161 APPLICATION FOR BENEFITS UNDER THE ITALY-U.S. INTERNATIONAL SOCIAL SECURITY AGREEMENT
0960-0160 Government Pension Questionnaire
0960-0159 MEDICAL REPORT (INDIVIDUAL WITH CHILDHOOD IMPAIREMENT)
0960-0158 STATE AGENCY OPERATIONS REPORT-WORKSHEET
0960-0157 STATISTICAL REPORT ON RECIPIENTS UNDER PUBLIC ASSISTANCE PROGRAM
0960-0156 QUALITY CONTROL NEGATIVE CASE ACTION WORKSHEET/REVIEW SCHEDULE - TABLE 1
0960-0154 CHILD SUPPORT ENFORCEMENT ACTIVITIES UNDER TITLE IV-D OF THE SOCIAL SECURITY ACT
0960-0152 MONTHLY "FLASH" REPORT OF SELECTED PROGRAM DATA SSA-3645
0960-0151 RECIPIENT FRAUD IN PUBLIC ASSISTANCE PROGRAMS
0960-0150 ANNUAL STATISTICAL REPORT ON CHILDREN IN FOSTER HOMES AND CHILDREN IN FAMILIES RECEIVING AFDC PAYMENT IN EXCESS OF THE POVERTY INCOME LEVEL
0960-0148 APPLICATIONS AND DISCONTINUANCES FOR AID TO FAMILIES WITH DEPENDENT CHILDREN (AFDC) AND MEDICAID
0960-0147 MEDICAL HISTORY AND DISABILITY REPORT - WIDOW, WIDOWER, SURVIVING DIVORCED WIFE, DISABLED CHILD
0960-0146 ADULT QUALITY CONTROL SUMMARY TABLES (1-4)
0960-0145 Statement for Determining Continuing Eligibility
0960-0144 Disability Report-Appeal
0960-0143 Student's Statement Regarding Resumption of School Attendance
0960-0142 Statement of Death by Funeral Director
0960-0141 Disability Report, Adult
0960-0140 Record of Supplemental Security Income Inquiry
0960-0139 QUARTERLY WORKLOAD AND ACTIVITY REPORT-SUPPLEMENTAL SECURITY INCOME PROGRAM
0960-0138 Letter to Employer Requesting Wage Information
0960-0136 CONFIRMATION OF SCHOOL ATTENDANCE
0960-0135 REPRESENTATIVE PAYEE REPORT FOR SUPPLEMENTAL SECURITY INCOME
0960-0134 EVALUATION AND MEASUREMENT SYSTEM - SUPPLEMENTAL SECURITY INCOME QUESTIONNAIRE
0960-0133 Supplemental Security Income-Quality Review Case Analysis
0960-0132 SSA STATE SSI INFORMATION EXCHANGE
0960-0131 STATEMENT FOR DETERMINING CONTINUING ELIGIBILITY FOR SUPPLEMENTAL SECURITY INCOME PAYMENTS
0960-0130 Quarterly Statistical Report on Recipients and Payments Under State-Administered Assistance Programs for Aged, Blind, and Disabled Recipients
0960-0129 VOCATIONAL SURVEY FORM - DISABILITY INSURANCE PROGRAM
0960-0128 Reporting Events - SSI
0960-0127 Agreement to Sell Property
0960-0126 REPORT OF STUDENT BENEFICIARY ABOUT TO ATTAIN AGE 22
0960-0125 APPLICATION TO BE SELECTED AS PAYEE FOR A SUPPLEMENTAL SECURITY INCOME RECIPIENT
0960-0124 Statement of Income and Resources
0960-0123 APPLICATION FOR SUPPLEMENTAL SECURITY INCOME (INDIVIDUAL WITH SPOUSE)
0960-0122 APPLICATION FOR SUPPLEMENTAL SECURITY INCOME (INDIVIDUAL)
0960-0121 APPLICATION FOR SUPPLEMENTAL SECURITY INCOME (COUPLE)
0960-0120 Pre-1957 Military Service Federal Questionnaire
0960-0119 REQUEST TO BE SELECTED AS PAYEE
0960-0118 Application for Benefits Under The Federal Mine Safety and and Dependent's Claim
0960-0116 Child Relationship Statement
0960-0115 SOCIAL SECURITY DISABLED PERSON REPORT
0960-0114 APPLICATION FOR BENEFITS BY A MENTAL INSTITUTION ON BEHALF OF A PATIENT
0960-0113 Statement Regarding Students' School Attendance
0960-0112 Report by Former Representative Payee
0960-0111 BENEFICIARY INFORMATION REPORT
0960-0110 State Mental Institution Policy Review
0960-0109 Statement of Care and Responsibility for Beneficiary
0960-0108 Report of Work Activity, Continuing Disability
0960-0105 Advanced Notice of Termination of Child's Benefits, and Student's Statement Regarding School Attendance
0960-0104 Petition To Obtain Approval of A Fee For Representing A Claimant Before The Social Security Administration
0960-0103 Supplemental Statement Regarding Farming Activities of Persons Living Outside the U.S.A.
0960-0102 Medical Report (Individual with Childhood Impairment)
0960-0101 Claim for Amounts Due in the Case of a Deceased Beneficiary
0960-0100 VOLUNTARY STATEMENT
0960-0098 Request for Workers' Compensation/Public Disability Benefit Information
0960-0097 Application for Search of Census Records for Proof of Age
0960-0096 Application for Special Age-72-or-Over Monthly Payments
0960-0095 PUBLIC ASSISTANCE AGENCY INFORMATION REQUEST
0960-0094 REPORT BY PERSON ENTITLED TO SPECIAL AGE 72 PAYMENTS
0960-0093 Certification by Religious Group
0960-0092 REQUEST FOR ENROLLMENT IN SUPPLEMENTARY MEDICAL INSURANCE
0960-0091 APPLICATION FOR HOSPITAL INSURANCE
0960-0090 SSA-1371, Statement by School Official About Student's Attendance, and SSA-1371-FC, Statement to U.S. Social Security Administration (SSA) By School Outside the United States......
0960-0089 Report of Student Beneficiary at End of School Year
0960-0088 Student Reporting Form
0960-0086 Chinese Custom Marriage Statement; Statement Regarding Chinese Custom Marriage
0960-0084 Report on Individual with Childhood Impairment
0960-0083 STATEMENT OF INSTITUTION OR SOCIAL AGENCY
0960-0078 Railroad Employment Questionnaire
0960-0077 STATEMENT ABOUT DISABILITY BY PERSON OUTSIDE THE U.S.
0960-0076 REPORT TO SOCIAL SECURITY ADMINISTRATION BY PERSON OUTSIDE THE UNITED STATES
0960-0073 Reporting Changes That Affect Your Social Security Payment
0960-0072 Continuing Disability Review Report
0960-0071 Report of New Information in Disability Cases
0960-0069 Representative Payee Evaluation Report
0960-0068 Representative Payee Report (Adult, Child, and Organizational Representative Payee)
0960-0067 REQUEST FOR MEDICAL REPORT HOSPITAL PULMONARY TUBERCULOSIS
0960-0066 Application for a Social Security Card
0960-0064 Farm Arrangement Questionnaire
0960-0063 REQUEST FOR RECONSIDERATION
0960-0062 Application for Survivor's Benefits
0960-0061 Farm Self-Employment Questionnaire
0960-0060 Application for Disability Insurance Benefits - 20 CFR, Subpart P, 404.1501-.1512 and Subpart D, 404.315-.322
0960-0059 Work Activity Report--Employee
0960-0058 Report on Individual with Mental Impairment
0960-0057 Annual Report of Earnings
0960-0052 Medical Report (General)
0960-0051 Supplement To Claim of Person Outside the United States
0960-0050 Questionnaire About Employment or Self-Employment Outside the United States
0960-0049 Report to U.S. SSA by Person Receiving Benefits for a Child or Adult Unable to Handle Funds/Report to U.S. SSA
0960-0048 STATEMENT OF PERSON REQUESTING PAYMENT ON BEHALF OF ESTATE
0960-0047 DOMESTIC SERVICE QUESTIONNAIRE
0960-0046 Statement of Self-Employment Income
0960-0045 Statement of Claimant or Other Person
0960-0044 STATES REPORT OF ADJUSTMENTS
0960-0043 STATE'S QUARTERLY REPORT OF WAGES PAID
0960-0042 RECAPITULATION OF STATE'S REPORT OF WAGES PAID
0960-0041 Wage and Contributions Paid Prior to 1987 - 20 CFR, Subpart M, 404.1237 and .1249
0960-0040 Employment Relationship Questionnaire
0960-0038 Statement of Marital Relationship
0960-0037 Request for Waiver of Overpayment Recovery or Change in Repayment Rate
0960-0036 Statement of Agricultural Employer (Year Prior to 1988; 1988 and Later)
0960-0034 Letter to Employer Requesting Information About Wages Earned by Beneficiary
0960-0031 STATEMENT REGARDING WAGES BY PERSON HAVING KNOWLEDGE THEREOF
0960-0030 Statement of Employer
0960-0029 Request for Correction of Earnings Record
0960-0027 SICK PAY AND PLAN OR SYSTEM QUESTIONNAIRE
0960-0025 Partnership Questionnaire
0960-0024 Medical Source Opinion of Patient’s Capability to Manage Benefits
0960-0020 Statement Regarding Contributions
0960-0019 Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody
0960-0018 CERTIFICATE OF APPLICANT FOR PAYMENTS ON BEHALF OF ANOTHER
0960-0017 Statement Regarding Marriage
0960-0016 Statement Regarding Date of Birth and Citizenship
0960-0015 Request for Withdrawal of Application
0960-0014 Request to be Selected as a Payee
0960-0013 Application for Lump-Sum Death Payment
0960-0012 Application for Parent's Insurance Benefits
0960-0011 APPLICATION FOR SURVIVING CHILD'S INSURANCE BENEFITS
0960-0010 Application for Child's Insurance Benefits
0960-0009 Marriage Certification
0960-0008 Application for Wife's or Husband's Insurance Benefits - 20 CFR, Subpart D, 404.330-.333; Subpart G, 404.603
0960-0007 Application for Retirement Insurance Benefits
0960-0006 REQUEST FOR CHANGE IN SOCIAL SECURITY RECORDS
0960-0005 ESTABLISHMENT REPORTING PLAN - LIST OF ESTABLISHMENTS OR REPORTING UNITS
0960-0004 Application for Widow's or Widower's Insurance Benefits
0960-0003 Application for Mother's or Father's Insurance Benefits
0960-0002 Statement Regarding the Inferred Death of an Individual by Reason of Continued and Unexplained Absence
0960-0001 Certificate of Support

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