Request for Deceased Individual's Social Security Record

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Social Security Online
Electronic Freedom of Information Act
www.socialsecurity.gov

Request for Deceased Individual's Social
Security Record
Form SSA-711 Internet Request
Form Approved: OMB No. 0960-0665
Expiration Date: 11/30/2012

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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
We use the "120 year rule" when disclosing information from our records for extremely aged
persons when no date of death exists. We normally do not assume that an individual is
deceased without proof of death (e.g., death certificate, obituary, newspaper article, or police
report).
Also, under our current policy, we do not release the parents' names unless they are proven

deceased, have a birth date more than 120 years ago, or the number holder on the SS-5 is at
least 100 years of age.

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

Day

Year

Sex
Male

Female

Deceased Individual's Parents' Information

Mother's maiden name

First

Middle

Last

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 REDUCTION And PRIVACY ACT STATEMENT
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SSA will insert the following revised Privacy Act and PRA Statements into the form at its next
scheduled reprinting:

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 this information. We will use this information to respond to your request.
Furnishing us the information is voluntary. However, failing to provide us with all or part of the
requested information may prevent us from accurately responding to your request.
We rarely use this information for any purpose other than to respond to requests for our
information. 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 a Congressional office requesting information on your behalf;
2. To the Department of Justice (DOJ) for use in representing the Federal Government;
3. To comply with Federal laws requiring the release of information from Social Security
records (e.g., to the Government Accountability Office and the Department of Veterans’
Affairs);
4. To facilitate statistical research, audit and investigatory activities necessary to assure the
integrity and improvement of Social Security programs.
A complete list of routine uses of this information is available in our Privacy Act Systems of
Records Notices, 60-0340, Electronic Freedom of Information Act (eFoia) System. This notice,
additional information regarding our programs and systems, are available online at
www.socialsecurity.gov or at any 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
(OMB) control number. We estimate that it will take about 7 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.