Authorization to the Social Security Administration to Obtain Personal Information

SOCIAL SECURITY ADMINISTRATION
Office of Quality Performance

Date:
Applicant Name:
SSN:

In order to proceed with the review, the following is needed:

Please send the requested documents in the enclosed self-addressed, postage-paid
envelope. We will return your documents immediately.
If you have questions about this request, contact me at
between 8:00 a.m. and 4:00 p.m., Monday through Friday.
Thank you for your cooperation.

Sincerely,

Social Insurance Specialist
Enclosure(s)

Form SSA-L2938 (08-2011)

PAPER REDUCTION ACT NOTICE
Paperwork Reduction Act Statement - This information collection meets the
requirements of 44 U.S.C section 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. The OMB number for this
collection is 0960-0066. We estimate that it will take about 15 minutes to read the
instructions, gather the facts, and answer the questions. Send only comments on our
time estimate above to: SSA, 1338 Annex Building, Baltimore, MD 21235-0001.

Form SSA-L2938 (08-2011)