Form SSA-7050-F4 Request fo Social Security Earning Information

Form Approved
OMB No. 0960-0525

Social Security Administration

REQUEST FOR SOCIAL SECURITY EARNINGS INFORMATION
*Use This Form If You Need

1. Certified/Non-Certified Detailed Earnings Information
Includes periods of employment or self-employment and
the names and addresses of employers.

DO NOT USE THIS FORM FOR:
Non-certified yearly totals of earnings
This service is free to the public.

OR
2. Certified Yearly Totals of Earnings
Includes total earnings for each year but does not include
the names and addresses of employers.

These totals can be obtained by calling
1-800-772-1213 to receive Form SSA-7004,
Request for Social Security Statement

Privacy Act Statement
Collection and Use of Personal Information
Section 205 of the Social Security Act, as amended, authorizes us to collect the information on this form. We will use the information you
provide to identify your records and send the earnings information you request. Completion of this form is voluntary; however, failure to do
so may prevent your request from being processed.
We rarely use the information in your earnings record for any purpose other than for determining your entitlement to Social Security benefits.
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 and 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 and improvement of Social Security
programs.
A complete list of routine uses for earnings information is available in our Systems of Records Notices entitled, the Earnings Recording and
Self-Employment Income System
(60-0059), the Master Beneficiary Record (60-0090), and the SSA-Initiated Personal Earnings and Benefit Estimate Statement (60-0224).
In addition, you may choose to pay for the earnings information you requested with a credit card. 31 C.F.R. Part 206 specifically authorizes
us to collect credit card information. The information you provide about your credit card is voluntary. Providing payment information is only
necessary if you are making payment by credit card. You do not need to fill out the credit card information if you choose another means of
payment (for example, by check or money order). If you choose the credit card payment option, we will provide the information you give us
to the banks handling your credit card account and the Social Security Administration's (SSA) account.
Routine uses applicable to credit card information, include but are not limited to:
(1) to enable a third party or an agency to assist Social Security to effect a salary or an administrative offset or to an agent of SSA that is a
consumer reporting agency for preparation of a commercial credit report in accordance with 31 U.S.C. §§ 3711, 3717 and 3718; and (2) to a
consumer reporting agency or debt collection agent to aid in the collection of outstanding debts to the Federal Government.
A complete list of routine uses for credit card information is available in our System of Records Notice entitled, the Financial Transactions of
SSA Accounting and Finance Offices (60-0231). The notice, additional information regarding this form, routine uses of information, and our
programs and systems is available on-line at www.socialsecurity.gov or at your local 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 11 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.
Form SSA-7050-F4 (xx-xxxx) EF (xx-xxxx)
Destroy prior editions

INFORMATION ABOUT YOUR REQUEST
•

How Do I Get This Information?

and it does not agree with your records), we
will supply you with more detail for the period
in question. Occasionally, earnings amounts
are wrong because an employer did not
correctly report earnings or earnings are
credited to the wrong person. In situations like
these, we will send you detailed information, at
no charge, so we can correct your record.

You need to complete the attached form to tell us
what information you want.
•

Can I Get This Information For Someone Else?
Yes, if you have their written permission. For
more information, see page 3.

•

Be sure to show the year(s) involved on the
request form and explain why you need the
information. If you do not tell us why you need
the information, we will charge a fee.

Who Can Sign On Behalf Of The Individual?
The parent of a minor child, or the legal guardian of
an individual who has been declared legally
incompetent, may sign if he/she is acting on behalf
of the individual.

•

We will certify the detailed earnings information
for an additional fee of $15.00. Certification is
usually not necessary unless you plan to use the
information in court.

Is There A Fee For This Information?
1. Certified/Non-Certified Detailed
Earnings Information

2. Certified Yearly Totals of Earnings
Yes, there is a fee of $15 to certify yearly totals
of earnings. Certification is usually not
necessary unless you plan to use the information
in court.

Yes, we usually charge a fee for detailed
information. In most cases, this information is used
for purposes NOT directly related to Social
Security such as for a private pension plan or
personal injury suit. The fee chart on page 3 gives
the amount of the charge.

3. Method of Payment
Enclose a check or money order for the entire
fee required. Payment can also be made by
credit card. To do so, complete page 4 of this
form and return it with your request form.

Sometimes, there is no charge for detailed
information. If you have reason to believe your
earnings are not correct (for example, you have
previously received earnings information from us

Form SSA-7050-F4 (xx-xxxx) EF (xx-xxxx)

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REQUEST FOR SOCIAL SECURITY EARNINGS INFORMATION
1. From whose record do you need the earnings information?
Print the Name, Social Security Number (SSN), and date of birth below.
Name

Social Security
Number

Other Name(s) Used
(Include Maiden Name)

Date of Birth
(Mo/Day/Yr)

2. What kind of information do you need?
For the period(s)/year(s):

Detailed Earnings Information
(If you check this block, tell us below
why you need this information.)

For the year(s):
Certified Yearly Totals of Earnings
(Check this box only if you want the information
certified. Otherwise, call 1-800-772-1213 to
request Form SSA-7004, Request for Social
Security Statement)
3. If you owe us a fee for this detailed earnings information, enter the amount due
using the chart on page 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Do you want us to certify the information?

Yes

A. $
No

If yes, enter $15.00 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B. $
ADD the amounts on lines A and B, and
enter the TOTAL amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C. $

• You can pay by CREDIT CARD by completing and returning the form on page 4, or
• Send your CHECK or MONEY ORDER for the amount on line C with the request and
make check or money order payable to "Social Security Administration"

• DO NOT SEND CASH.

4. If you would like this information sent to you, please fill in the information below:
Name

Address

City, State & Zip Code
5. If you would like the information sent to someone else, please fill in the information below. I authorize the Social
Security Administration to release my earnings information to:
Name

Address

City, State & Zip Code
6. I am the individual to whom the record pertains (or a person who is authorized to sign on behalf of that individual).
I understand that any false representation to knowingly and willfully obtain information from Social Security
records is punishable by a fine of not more than $5,000 or one year in prison.
SIGN your name here
(Do not print) >

Date

Daytime Phone Number
(Area Code) (Telephone Number)

Form SSA-7050-F4 (xx-xxxx) EF (xx-xxxx)

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Exception: If using private contractor (e.g., FedEx) to mail form(s), use:

7. Mail Completed Form(s) To:

Social Security Administration
Division of Earnings Record Operations
300 N. Greene St.
Baltimore, Maryland 21290-0300

Social Security Administration
Division of Earnings Record Operations
P.O. Box 33003
Baltimore, Maryland 21290-3003

REQUEST FOR SOCIAL SECURITY EARNINGS INFORMATION
How Much Do I Have to Pay For Detailed Earnings?
1. Count the number of years for which you need detailed earnings information. Be sure to add in both the first and last year
requested. However, do not add in the current calendar year since this information is not yet available.
2. Use the chart below to determine the correct fee.

Number of Years Requested

Fee

Number of Years Requested

Fee

Number of Years Requested

Fee

1

$15.00

15

$ 43.75

28

$ 64.50

2

17.50

16

45.50

29

66.00

3

20.00

17

47.25

30

67.50

4

22.50

18

49.00

31

68.75

5

25.00

19

50.75

32

70.00

6

27.00

20

52.50

33

71.25

7

29.00

21

54.00

34

72.50

8

31.00

22

55.50

35

73.75

9

33.00

23

57.00

36

75.00

10

35.00

24

58.50

37

76.25

11

36.75

25

60.00

38

77.50

12

38.50

26

61.50

39

78.75

13

40.25

27

63.00

40

80.00

14

42.00
For Requests Over 40 Years, Please Add 1 Dollar for Each Additional Year.

Form SSA-7050-F4 (xx-xxxx) EF (xx-xxxx)

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•

Whose Earnings Can Be Requested
1. Your Earnings

3. A Deceased Person's Earnings
You can request earnings information from the record of
a deceased person if you are the legal representative of
the estate, a survivor (that is, the spouse, parent, child,
divorced spouse of divorced parent), or an individual
with a material interest (example-financial) who is an
heir at law, next of kin, beneficiary under the will or
donee of property of the decedent.

You can request earnings information from your own
record by completing the attached form; we need your
handwritten signature. If you sign with an "X", your
mark must be witnessed by two disinterested persons
who must sign their name and address.
2. Someone Else's Earnings
You can request earnings information from the record of
someone else if that person tells us in writing to give the
information to you. This writing or "authorization" must
be presented to us within 60 days of the date it was
signed by that person.

Proof of death must be included with your request.
Proof of appointment as representative or proof of your
relationship to the deceased must also be included.

YOU CAN MAKE YOUR PAYMENT BY CREDIT CARD

As a convenience, we offer you the option to make your payment by credit card. However, regular credit card rules will apply.
You may also pay by check or money order.

Exception:
If using private contractor (e.g., FedEx) to mail form(s), use:

Please fill in all the information below and return
this form along with your request to:
Social Security Administration
Division of Earnings Record Operations
P.O. Box 33003
Baltimore, Maryland 21290-3003

Social Security Administration
Division of Earnings Record Operations
300 N. Greene St.
Baltimore, Maryland 21290-0300

Note: Please read Paperwork/Privacy Act Notice
CHECK ONE

¢

Credit Card Holder's Name

¢

(Enter the name from the credit card)

Credit Card Holder's Address

Visa

American Express

MasterCard

Discover

Diners Card

First Name, Middle Initial, Last Name

Number & Street

¢

City, State, & Zip Code

Daytime Telephone Number

¢

Credit Card Number

¢

Credit Card Expiration Date

¢

Amount Charged

¢

Credit Card Holder's Signature

¢

Area Code

Telephone Number

--

Month

--

--

Year

$

Authorization

DO NOT WRITE IN THIS SPACE
OFFICE USE ONLY

Name

Remittance Control #
Form SSA-7050-F4 (xx-xxxx) EF (xx-xxxx)

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Date