Form SSA-L707 Request for Proof(s) from Custodian of Records

Form Approved
OMB No. 0960-0766

Social Security Administration
REQUEST FOR PROOF(S) FROM CUSTODIAN OF RECORDS
DATE:
Number Holder: __________________________

Unit Number: _________________________
TO: CUSTODIAN OF RECORDS
___________________________________
Address
___________________________________
Address
___________________________________
City
State
ZIP Code

• Please furnish a certified copy of your record or a Letter of No Record of the following
event(s):
Marriage
Divorce
Death
See page 2 for details. Include this form with your response.
• Verification of Requester's Identity (if required)
Proof of the requester's identity is attached.
•The document is needed for Social Security Administration purposes.
• Enclosed is $ _____________________ in the form of:
Personal Check
Certified Check
Money Order
Credit Card (Type, Number, Expiration Date, Name as shown on
card _______________________________________________________
Other (specify) _____________________________________________
No Fee Required
Do not send cash.
• Please send the document(s) to (check one):
OR

The Social Security Office

My address below
(Please Print)

(Please Print)
Social Security Administration
Attention: ________________________
___________________________________
Address
___________________________________
Address
___________________________________
City
State
ZIP Code

Name
___________________________________
Address
___________________________________
Address
___________________________________
City
State
ZIP Code

I authorize the disclosure of the requested information to the Social Security Administration.
NAME OF REQUESTOR

Destroy Prior Editions

RELATIONSHIP TO PERSON
ON RECORD

SIGNATURE OF REQUESTOR

Form SSA-L707 (09-2008) EF (09-2008)

•The following information may assist you in locating the correct record:
DEATH RECORD
Full Name of Deceased (first, middle, last) _________________________________________________
Date of Death (month, day, year) _________________________________________________________
Sex _____________________________ State of Birth _______________________________________
Place of Death (city, county if known, state) ________________________________________________
• If unable to locate record, please indicate years searched and sign. ________________________________
MARRIAGE RECORD
Name of Groom or Party 1 (first, middle, last) _______________________________________________
Date of Birth (month, day, year) __________________________________________________________
Place of Birth _________________________________________________________________________
Name of Bride or Party 2 (first, middle, last) _________________________________________________
Date of Birth (month, day, year) __________________________________________________________
Place of Birth _________________________________________________________________________
Date of Marriage (month, day, year) _______________________________________________________
If date unknown, year(s) to be searched ____________________________________________________
County that issued license _______________________________________________________________
County and state where marriage occurred __________________________________________________
If checked, please include age or birth date of _____________________ as shown on the marriage record.
• If unable to locate record, please indicate years searched and sign. ________________________________
DIVORCE RECORD
Name of Husband or Party 1 (first, middle, last) _______________________________________________
Date of Birth (month, day, year) __________________________________________________________
Name of Wife or Party 2 (first, middle, maiden)_______________________________________________
Date of Birth (month, day, year) __________________________________________________________
Date of Divorce (month, day, year) _______________________________________________________
If date unknown, year(s) to be searched ____________________________________________________
County and state where divorce occurred __________________________________________________
• If unable to locate record, please indicate years searched and sign. ________________________________

See Revised Privacy Act
Statement
Privacy Act - The Privacy Act requires us to notify you that we are authorized to collect this information by
section 205 (a) of the Social Security Act. You do not have to provide the information requested. The data you
provide, however, will allow the Social Security Administration to determine the eligibility for benefits of a person
who is applying for Social Security or Supplemental Security Income benefits. If you do not complete this form,
that person may not be entitled to benefits. We do not disclose the information you provide to any person or
other government agency. We may also use the information you give us when we match records by computer.
Matching programs compare our records with those of other Federal, State, or local government agencies. Many
agencies may use matching programs to find or prove that a person qualifies for benefits paid by the Federal
government. The law allows us to do this even if you do not agree to it. Explanations about these and other
reasons why information you give us may be used or given out are available in Social Security offices. If you
want to learn more about this, contact any Social Security office.
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
10 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.

See Revised Paperwork
Reduction Act Statement
Destroy Prior Editions

Form SSA-L707 (09-2008) EF (09-2008)

SSA will insert the following revised Privacy Act Statement into the form
at its next scheduled reprinting:
Request for Proof(s) From Custodian of Records
Form, SSA-L707
Privacy Act Statement
Collection and Use of Personal Information

Section 205(a) of the Social Security Act as amended [42 U.S.C. 405(a)], authorizes us to
collect this information. The information you provide will allow us to determine
eligibility for benefits of a person who is applying for Social Security or Supplemental
Security Income benefits. Your response is voluntary, however, your failure to complete
this form may prevent us from making an accurate or timely decision on the named
person’s eligibility for benefits.
We rarely use the information you provide on this form for any purpose other than for the
reasons explained above. However, we may use it for the administration and integrity of
Social Security programs. We may also disclose information to another person or to
another agency in accordance with approved routine uses, which include but are not
limited to the following:
1. To enable a third party or an agency to assist Social Security in establishing
rights to Social Security benefits and/or coverage;
2. To comply with Federal laws requiring the release of information from Social
Security records (e.g., to the Government Accountability Office, General
Services Administration, National Archives Records Administration, and the
Department of Veterans Affairs);
3. To make determinations for eligibility in similar health and income
maintenance programs at the Federal, State, and local level; and
4. To facilitate statistical research, audit, or investigative activities necessary to
assure the integrity of Social Security programs.
We may also use the information you provide in computer matching programs.
Matching programs compare our records with records kept by other Federal, State or
local government agencies. Information from these matching agencies can be used to
establish or verify a person’s eligibility for Federally-funded or administered benefit
programs and for repayment of payments or delinquent debts under these programs.
A complete list of routine uses for this information is available in our Systems of Records
Notices entitled, Claims Folder System, 60-0089, and Supplemental Security Income
Record, and Veterans Benefits, 60-0103. The notices, additional information regarding
this form, and information regarding our system and programs, are available on-line at
www.socialsecurity.gov or at any local Social Security office.

SSA will insert the following revised PRA Statement 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 10
minutes to read the instructions, gather the facts, and answer the questions. Send only
comments relating to our time estimate above to: SSA, 6401 Security Blvd, Baltimore,
MD 21235-6401.