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

Form Approved
0MB No. 0960-0665

Social Security Administration

REQUEST FOR DECEASED INDIVIDUAL'S
SOCIAL SECURITY RECORD
*Use This Form If You Need
1. Photocopy of Original Application for a Social Security Card (SS-5).
OR

2. Computer extract of Social Security Card Application.

INFORMATION ABOUT YOUR REQUEST
• 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.
• 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 $24.00.
If SSN of deceased individual is not provided, the fee is '.$24.601.
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 :$22:QQJ.
If SSN of deceased individual is not provided, the fee is $22.00 .
Certified copy is provided for an additional fee of $10.00 (See instructions below)
• SSN Search required.
Complete as much information as possible in Blocks 4 and 5, 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 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.

FORM SSA-711 (11-2016)
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SSA will insert the following revised Privacy Act Statement into the form as soon
as possible:
Privacy Act Statement
Collection and Use of Personal Information

The Freedom of Information Act (FOIA) (5 U.S.C. § 552) and our regulations at 20 CFR
402.130 allow us to collect this information. Furnishing us this information is voluntary.
However, failing to provide all or part of the information may prevent us from accurately
responding to your FOIA request.
We will use the information to verify the subject individual is deceased, access the correct Social
Security record, and process your request. We may also share your information for the following
purposes, called routine uses:
•

To student volunteers, individuals working under a personal services contract, and other
workers who technically do not have the status of Federal employees, when they are
performing work for the Social Security Administration (SSA), as authorized by law, and
they need access to personally identifiable information in SSA records to perform their
agency assigned functions; and

•

To National Archives and Records Administration, Office of Government Information
Services (OGIS), to the extent necessary to fulfill its responsibilities in 5 U.S.C. 552(h) to
review administrative agency policies, procedures and compliance with the FOIA, and to
facilitate OGIS’ offering of mediation services to resolve disputes between persons
making FOIA requests and administrative agencies.

In addition, we may share this information in accordance with the Privacy Act and other Federal
laws. For example, where authorized, we may use and disclose this information in computer
matching programs, in which our records are compared with other records to establish or verify a
person’s eligibility for Federal benefit programs and for repayment of incorrect or delinquent
debts under these programs.
A list of additional routine uses is available in our Privacy Act System of Records Notice
(SORN) 60-0340, entitled FOIA and Privacy Act Record Request and Appeal System, as
published in the Federal Register (FR) on July 13, 2016, at 81 FR 45352. Additional
information, and a full listing of all our SORNs, is available on our website at
www.ssa.gov/privacy.