Request for Deceased Individual's Social Security Record

Request for Deceased Individual's Social Security Record (Form SSA-711)

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Electronic Freedom of Information Act
Request for Deceased Individual's Social Security Record
Form SSA-711 Internet Request
Form Approved: OMB No. 0960-0665

For information on how to complete this form, follow the form instructions.
Request Type and Fee

Photocopy of Original Application for a Social Security Card (SS-5)
$27.00, SSN of deceased individual is provided
$29.00, SSN of deceased individual is not provided

Computer Extract of Social Security Card Application
$16.00, SSN of deceased individual is provided
$18.00, SSN of deceased individual is not provided
Certification is required, adds $10.00 to fee

Deceased Individual's Information
Name of individual at birth
First

Middle

Last

Name(s) of individual (if other than above/other name(s) used)

Social Security Number

Date of birth
Month

Sex
Male

Day

Year

Female

Deceased Individual's Parents' Information
Mother's maiden name
First

Middle

Last

https://secure.ssa.gov/apps7/eFOIA-FEWeb/internet/main.jsp

6/9/2009

Request for Deceased Individual's Social Security Record (Form SSA-711)

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Mother's married name(s)

Father's name
First

Middle

Last

Requester's Information
Name
First

Middle

Last

Address
Street Address 1
Street Address 2
City

State

Zip

Telephone

Fax

E-mail

Cancel

Submit

PAPERWORK/PRIVACY ACT STATEMENT

Privacy Policy | Website Policies & Other Important
Information | Site Map

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6/9/2009

Form SSA-711 Instruction

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Electronic Freedom of Information Act
Request for Deceased Individual's Social Security Record
Use This eForm If You Need
Photocopy of Original Application for a Social Security Card (SS-5), or
Computer Extract of Social Security Card Application.

Information About Your Request
How Do I Get This Information?
Complete the eForm request for deceased individual's Social Security record (Form SSA-711) to tell us what
information you want.
Is There A Fee For This Information? Yes
Photocopy of Original Application for Social Security Card (SS-5)
If SSN of deceased individual is provided, the fee is $27.00
If SSN of deceased individual is not provided, the fee is $29.00

Computer Extract of SS-5 (May not contain the name of the individual's parents and the place of birth)
If SSN of deceased individual is provided, the fee is $16.00
If SSN of deceased individual is not provided, the fee is $18.00

Certified copy is provided for an additional fee of $10.00 (See instructions below).
SSN Search Required.
Photocopy of Original Application for Social Security Card (SS-5): Complete as much information as possible
under the Deceased Individuals and Parents Information sections, if the deceased individual's SSN is unknown.
When is Certification Required?
Certification is usually not necessary unless you plan to use the information in court.
Method of Payment
Payment can be made online with a credit card by completing the credit card information. When you have
completed the eForm, select the Pay Now button. You will receive an electronic confirmation and a reference
number of your successful transaction.
You may also choose to print and mail in your request.
If you mail your request, you may pay by credit card using form SSA-714 (Link to SSA-714) or with a check or
money order (Name, Address and Phone Number must appear on check. Name, Account Number and expiration
date must be provided for credit card payment). Enclose one check or money order or provide your credit card
information for the entire fee required (total from request(s)). DO NOT SEND CASH.
Forward Request to:
SSA OEO DERO FOIA
PO BOX 33022
BALTIMORE MD 21290-3022
Forward Express Mail to:
SSA OEO DERO FOIA
300 N GREENE STREET

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6/9/2009

Form SSA-711 Instruction

Page 2 of 2

BALTIMORE MD 21290-0300

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Information | Site Map

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6/9/2009

Page 1 of1

Electronic Freedom ofInfonnation Act
~

PAPERWORK/PRIVACY ACT STATEMENT
See below for revised Paperwork Reduction Act and Privacy Act
Statements.

PAPERWORK REDUCTION ACT STATEMENT: This infonnation collection meets the clearance
requirements of 44 U.S.C. §3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You are not
required to answer these questions unless we display a valid Office of Management and Budget control number.
We estimate that it will take you about 7 minutes to read the instructions, gather the necessary facts, and answer
the questions. You may send comments on our time estimate above to: SSA, 6401 Security Blvd., Baltimore, MD
21235-6401. Send only comments relating to our time estimate to this address, not the completed form.
PRIVACY ACT STATEMENT: The Social Security Administration (SSA) has the authority to collect the
infonnation requested on this fonn under 5 U.S.c. § 552 and the applicable regulations at 20 CFR § 402.130. The
infonnation you provide will be used to respond to your request for infonnation or records maintained by SSA.
You do not have to give us this infonnation. However, without the infonnation we will be unable to respond to
your request.
Although the infonnation we obtain with this fonn is almost never used for any purpose other than the one stated
above, the infonnation may be disclosed by SSA without your consent if authorized by Federal laws such as the
Privacy Act and the Social Security Act. For example, SSA may disclose to a Congressional office requesting
infonnation on your behalf; to the Department of Justice (DOJ) for use in representing the Federal Government;
and to the General Services Administration and the National Archives and Records Administration to conduct
studies. Disclosure of any infonnation defined as "returns or return infonnation" under 26 U.S.c. § 6103 of the
IRC will not be disclosed unless authorized by a statute, the IRS, or IRS regulations.
Explanations about these and other reasons why infonnation you provide may be used or given out are available in
Social Security offices. If you want to learn more about this, you may contact any Social Security office.

Privacy Policy I Website Policies & Other Important
Infonnation I Site Map

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6/18/2009

The following revised PRA Statement and Privacy Act Statement will be
inserted into the form at its next scheduled reprinting:
Paperwork Reduction Act Statement - This information collection meets the
requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction
Act of 1995. You do not need to answer these questions unless we display a valid Office
of Management and Budget control number. We estimate that it will take about 7
minutes to read the instructions, gather the facts, and answer the questions. SEND OR
BRING THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY
OFFICE. The office is listed under U. S. Government agencies in your telephone
directory or you may call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).
You may send comments on our time estimate above to: SSA, 6401 Security Blvd,
Baltimore, MD 21235-6401. Send only comments relating to our time estimate to this
address, not the completed form.

REQUEST FOR DECEASED INDIVIDUAL’S SOCIAL SECURITY RECORD
*Use this form only if you need (1) a photocopy of the original application for a Social Security Card (SS-5) or (2) a
computer extract of the Social Security Card Application.
“Paperwork Reduction Act Statement – This information collection meets the requirements of 44 U.S.C. § 3507, as
amended by Section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we
display a valid Office of Management and Budget control number. We estimate that it will take about 7 minutes to read
PRA above
statement
the instructions, gather the facts, and answer the questions. Send only commentsInsert
on ourrevised
time estimate
to: SSA,
1338 Annex Building, 6401 Security Boulevard, Baltimore, Maryland 21235-6401.” here.

INFORMATION ABOUT YOUR REQUEST
o

How Do I Get This Information? Complete page 2 of this form to tell us what information you want. Photocopy
page 2 for multiple requests.

o

Is There A Fee For This Information? Yes.
Photocopy of Original Application for Social Security Card (SS-5)
If SSN of deceased individual is provided, the fee is $27.00.
If SSN of deceased individual is not provided, the fee is $29.00.
Computer Extract of SS-5 (may not contain the names of the individual’s parents and the place of birth)
If SSN of deceased individual is provided, the fee is $16.00.
If SSN of deceased individual is not provided, the fee is $18.00.
Certified copy is provided for an additional fee of $10.00 (See instructions below).

o

SSN Search required.
Complete as much information as possible in Blocks 4 and 5, if the deceased individual’s SSN is unknown.

o

When is Certification required?
Certification is usually not necessary unless you plan to use the information in court.

o

Method of Payment.
Payment can be made with a credit card by completing the attached Form SSA-714 and returning it with your
request(s) form. You may also pay with a check or money order (Name, Address and Phone Number must
appear on Check). Enclose one check or money order for the entire fee required (total from request(s)). DO
NOT SEND CASH.

PRIVACY ACT STATEMENT
Collection and Use of Personal Information
The Freedom of Information Act at 5 U.S.C. § 552 and our regulations at 20 C.F.R. § 402.130 authorize us to collect the
information on this form. The information you provide will be used to respond to your request for SSA records information
and may be used to facilitate statistical research, audit, or investigative activities necessary to ensure the integrity of SSA
programs. Your response is voluntary; however, failure to provide all or part of the requested information could prevent us
from being able to accurately respond to your request.
We rarely use the information provided on this form for any purpose other than to respond to requests for SSA records
information. However, in accordance with 5 U.S.C. § 552a(b) of the Privacy Act, we may disclose the information
provided on this form (1) to comply with Federal laws requiring the disclosure of the information from our records; (2) to a
Congressional office requesting information on your behalf; (3) to the Department of Justice (DOJ) for use in representing
the Federal Government; and (4) to the General Services Administration and the National Archives and Records
Administration to conduct studies.
A complete list of routine uses of this information is contained in our System of Records Notice 60-0340 (Electronic
Freedom of Information Act (e-FOIA) System). Additional information regarding this form and our other systems of
records notices and Social Security programs are available from our Internet website at www.socialsecurity.gov or at your
local Social Security office.