Credit Card Payment Form

OMB 0960-0648

OMB 0960-0648

SSA uses Form SSA-1414 to process: (1) Credit card payments from former employees and vendors who have outstanding debts owed to the agency; (2) advance payments for reimbursable agreements; and (3) credit card payment for all Freedom of Information Act (FOIA) requests requiring payment. The respondents are former employees, and vendors who have outstanding debts to the agency; entities who have reimbursable agreements with SSA; and individuals who request information through FOIA.

The latest form for Credit Card Payment Form expires 2021-12-31 and can be found here.

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