c. Consent for Release of Records (Electronic SSA-3288-OP1)+

Creating Advanced Streamlined Electronic Services for
Constituents (CASES) Act
Release 3.0
Webform Application
Screen Package
July 15, 2025

Application Landing Page ........................................................................................................................................................ 3
Authentication ........................................................................................................................................................................ 4
Privacy Act Statement and Terms of Service .......................................................................................................................... 6
OMB Dialog ............................................................................................................................................................................. 7
Help Dialog .............................................................................................................................................................................. 8
Identity-Proofing and Authentication ..................................................................................................................................... 9
Description of Requested Records ........................................................................................................................................ 10
Add Recipients ...................................................................................................................................................................... 28
Release Reason ..................................................................................................................................................................... 32
Review and Submit ............................................................................................................................................................... 33
Confirmation ......................................................................................................................................................................... 34
Appendix ............................................................................................................................................................................... 35

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Application Landing Page

Users can access the SSA-3288-OP1 in two ways: 1) by typing in SSA.gov/privacy, selecting “Submit an Electronic Consent
to Disclose Records”, then selecting the “click here” hyperlink on that page, or 2) by typing in search terms at SSA.gov to
find the Electronic Consent to Disclose Records link and then selecting the “click here” hyperlink on that page.

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Authentication

User is brought to the user login screen. User selects to sign in by clicking “Sign in with Login.gov” or “Sign in with
ID.me”.1

1

The CASES Act application relies on SSA’s common identity proofing and authentication processes (including OMB No. 0960-0789,
SSA’s Public Credentialing and Authentication Process) to meet the identity proofing and authentication requirements as laid out in
the CASES Act and OMB M-21-04. To demonstrate a typical user experience for signing into the CASES application, we have included
current, OMB-approved authentication screens on pages 4-5 of this package. These screens are external to the CASES Act
application.

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User selects the “I agree to the Terms of Service” checkbox and clicks the “Next” button.

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Privacy Act Statement and Terms of Service

After checking the box to agree to the General Terms of Service and clicking ‘Next’, the user will be presented with the
Privacy Act Statement and Terms of Service for the online Form SSA-3288-OP1. The user must select the “I Agree to the
Terms of Service” button to continue.

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OMB Dialog

If the user selects the OMB No. 0960-0566 link in the gray footer, a dialog displays form specific Paperwork Reduction
Act information.

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Help Dialog

If the user selects the Help link in the gray footer, a dialog displays Form Instructions.

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Identity-Proofing and Authentication

Identifying information for the authenticated individual is displayed to the user. If this information is incorrect, the user
must contact SSA to update the information. The user clicks the “Next” button to continue.

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Description of Requested Records

The user will have the option to select and add multiple record types from the drop-down menu by selecting the record
type and clicking the “Add Record” button. The user must select at least one record type.

Records available for the user to add include the records listed above.

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When adding the “Social Security benefit amount(s)” record type, users must either select the “Current monthly
Social Security benefit amount” or provide a specific date range for the benefit amounts.

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When adding the “Supplemental Security Income payment amount(s)” record type, users must either select the
“Current monthly Supplemental Security Income payment amount” or provide a specific date range for the payment
amounts.

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When adding the “Medicare entitlement” record type, users must either select “All Medicare entitlement” or
provide a specific date range for the Medicare entitlement information.

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When adding the “Medical Records from my Claims Folder(s)” record type, users must either select “All medical
records from my claims folder(s)” or provide a specific date range for the medical records.

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When adding the “Benefit or Payment Application(s)” record type, users must select a Benefit Type (i.e., Social
Security retirement, Social Security disability or Supplemental Security Income) from the drop down. Then, users
must either select “All [benefit type] applications” or provide a specific date range for the applications.

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When adding the “Award Notice(s)” record type, users must select a Benefit Type (i.e., Social Security retirement,
Social Security disability or Supplemental Security Income) from the drop down. Then, users must either select “All
[benefit type] award notices” or provide a specific date range for the award notices.

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When adding the “Denial Notice(s)” record type, users must select a Benefit Type (i.e., Social Security retirement,
Social Security disability or Supplemental Security Income) from the drop down. Then, users must either select “All
[benefit type] denial notices” or provide a specific date range for the denial notices.

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When adding the “Appeal Request(s)” record type, users must select a Benefit Type (i.e., Social Security retirement,
Social Security disability or Supplemental Security Income) from the drop down. Then, users must either select “All
[benefit type] appeal requests” or provide a specific date range for the appeal requests.

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After the user has selected the record type(s) they are requesting, they can either add additional record types,
remove them from the request, edit them or proceed by clicking the “Next” button.

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Add Recipients

The user must add at least one recipient for the requested records using the “Add Recipient” button. The recipient(s)
can be either an organization and/or a person. The form allows a maximum of three recipients.

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Add Person

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Add Organization/Company

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The user can remove or edit recipients after adding them or continue by clicking on the “Next” button.

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Release Reason

The user must select one of four reasons for requesting release of their records.

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Review and Submit

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On the Review and Submit page, the user can review and update any of the information they have input so far, as well
as view, print, or save an unsigned version of the form (see appendix item #1). Once they are ready to submit the
request, they can electronically sign the form by checking the box next to the eSignature statement. Providing a phone
number is optional.

Confirmation

Upon successful submission, the user receives a confirmation message and has an opportunity to open the signed form
in a new web browser. From the new window, the user can choose to print, save, or view and close the signed form. The
downloaded form will include an eSignature audit page with the details of the signature (see Appendix Item #3).

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Appendix
1. PDF preview of the form before submitting

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2. PDF version of the signed form

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3. eSignature audit page

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