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

• 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 __________
Date of Birth (month, day,year)______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) -------------------------PIace of Birth --------------------------------Date of Marriage (month, day, year)------------------------1 f date unknown, year(s) to be searched ----------------------County that issued license ---------------------------County and state where marriage occurred ---------------------• If unable to locate record, please indicate years searched ____and sign. _________
Divorce Record
Name of Spouse Husband or Party 1 (first, middle, last)
Date of Birth (month, day, year)

-----------------

--------------------------

Name of Spouse Wife or Party 2 (first, middle, last)

-----------------------

Date of Birth (month, day, year) :__________________________
--------------------------If date unknown, year(s) to be searched
-----------------------Date of Divorce (month, day, year)
County and state where divorce occurred----------------------• If unable to locate record, please indicate years searched ____and sign. _________

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Form SSA-L707 (06-2014) EF (06-2014)

See Revised
Privacy Act
Statement

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
Sections 205(a) and 1631(e) of the Social Security Act, as amended, allow us to collect this
information. Furnishing us this information is voluntary. However, failing to provide all or part
of the information may prevent an accurate and timely decision on any claim filed.
We will use the information to make a determination of eligibility for Social Security or
Supplemental Security Income benefits. We may also share your information for the following
purposes, called routine uses:
•

To third party contacts where necessary to establish or verify information provided by
representative payees or payee applicants;

•

To specified business and other community members and Federal, State, and local
agencies for verification of eligibility for benefits; and

•

To contractors and other Federal agencies, as necessary, for the purpose of assisting the
Social Security Administration in the efficient administration of its programs.

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 Notices
(SORN) 60-0089, entitled Claims Folders System, as published in the Federal Register (FR) on
April 1, 2003, at 68 FR 15784; 60-0090, entitled Master Beneficiary Record, as published in the
FR on January 11, 2006, at 71 FR 1826; and 60-0103, entitled Supplemental Security Income
Record and Special Veterans Benefits, as published in the FR on January 11, 2006, at 71 FR
1830. Additional information, and a full listing of all of our SORNs, is available on our website
at www.ssa.gov/privacy.

SSA will insert the following revised PRA Statement into the form as soon
as possible:
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. You can find your local Social Security office through SSA’s website at
www.socialsecurity.gov. Offices are also listed under U. S. Government agencies in
your telephone directory or you may call Social Security at 1-800-772-1213 (TTY 1800-325-0778). You may send comments regarding this burden estimate or any other
aspect of this collection, including suggestions for reducing this burden to: SSA, 6401
Security Blvd, Baltimore, MD 21235-6401. Send only comments relating to our time
estimate to this address, not the completed form.