Get SSA-711 2020

FORM SSA-711 03-2005 PROCESSING LIMITATIONS A Request for information CANNOT be processed for INDIVIDUALS WHO DIED BEFORE NOVEMBER 1936. OMB NO. 0960-0665 REQUEST FOR DECEASED INDIVIDUAL S SOCIAL SECURITY RECORD Use This Form If You Need 1. Request for photocopy of Original Application for Social Security Card SS-5. Enter 27. 00 if SSN of deceased individual is provided. 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. 00. Computer Extract of SS-5 May not contain the names of the individual s parents and the place of birth 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. Send only comments on our time estimate above to SSA 1338 Annex Building Baltimore MD 21235-6401. 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 If SSN of deceased individual is provided the fee is 27. 00. Computer Extract of SS-5 May not contain the names of the individual s parents and the place of birth Certified copy is provided for an additional fee of 10. 3507 as amended by Section 2 of the We estimate that it will take about 7 minutes to read the instructions gather the facts and answer the questions. Send only comments on our time estimate above to SSA 1338 Annex Building Baltimore MD 21235-6401. 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 If SSN of deceased individual is provided the fee is 27. DO NOT SEND SELF-ADDRESSED STAMPED ENVELOPE. DECEASED INDIVIDUAL S INFORMATION COMPLETE AS MUCH INFORMATON AS POSSIBLE Name of Individual at birth first middle last name Social Security Number M F Circle Sex Date of birth mo day yr Place of Birth City State or Foreign Country Mother s Maiden Name at birth first middle last name Mother s married name s Father s Name first middle and last name REQUESTER S INFORMATION PLEASE READ PRIVACY ACT STATEMENT BEFORE COMPLETING THIS SECTION Printed Name of Requester first middle last name Date Signature do not print unless this is your usual signature Street Address Telephone Number Forward Request to City State and Zip Code Fax Number SSA OEO DERO FOIA PO BOX 33022 BALTIMORE MD 21290-3022 E-Mail Address Forward Express Mail to 300 N GREENE ST.