Get SSA Request for Numident Printout Record

Request for Numident Printout Record To Social Security Administration OEO DERO FOIA Workgroup 300 N. Green Street P. Box 33022 Baltimore MD 21290-3022 To process your request for a copy of your Numident printout we need you to provide the following in formation ----------- fold here -------------------------------- Narne Date of Birth If you do not know your Social Security number please provide the following information Name Place of Birth Mother s Maiden Name Sex Father s Name In all cases also provide the following Mailing Address Daytime Phone Number I am the nonresident human being and not statutory individual to whom the false record pertains or a person who is authorized to sign this letter on behalf of that party. I understand that any false representation to knowingly and willfully obtain information from Social Security records is punishable by a fine of not more than 5 000 or one year in prison* Sincerely Signature Date Note There is a fee for obtaining this printout. If you know the SSN the charge if 16. 00 if the SSN is not known the charge is 18. 00. The applicable fee must accompany this request. You may pay by check money order or MasterCard Visa Discover American Express or Diner s Club credit card. Checks and money orders should be made payable to Social Security Administration. If paying by credit card please provide the following Type of Credit Card Card Holder s Name and SSN Card Holder s Address Amount to be charged Credit Card Number Month and Year of Expiration. I understand that any false representation to knowingly and willfully obtain information from Social Security records is punishable by a fine of not more than 5 000 or one year in prison* Sincerely Signature Date Note There is a fee for obtaining this printout. If you know the SSN the charge if 16. 00 if the SSN is not known the charge is 18. 00. The applicable fee must accompany this request. If you know the SSN the charge if 16. 00 if the SSN is not known the charge is 18. 00. The applicable fee must accompany this request. You may pay by check money order or MasterCard Visa Discover American Express or Diner s Club credit card. You may pay by check money order or MasterCard Visa Discover American Express or Diner s Club credit card. Checks and money orders should be made payable to Social Security Administration. If paying by credit card please provide the following Type of Credit Card Card Holder s Name and SSN Card Holder s Address Amount to be charged Credit Card Number Month and Year of Expiration. I understand that any false representation to knowingly and willfully obtain information from Social Security records is punishable by a fine of not more than 5 000 or one year in prison* Sincerely Signature Date Note There is a fee for obtaining this printout. If you know the SSN the charge if 16. 00 if the SSN is not known the charge is 18. 00. The applicable fee must accompany this request. You may pay by check money order or MasterCard Visa Discover American Express or Diner s Club credit card. .