Get Ssa Ssa-4641 2016-2025

The SSA SSA-4641 form serves as an authorization for the Social Security Administration to obtain account records from a financial institution. This guide provides detailed steps to help users fill out this important form online, ensuring all necessary information is included accurately.

Follow the steps to fill out the SSA SSA-4641 online effectively.

1. Press the ‘Get Form’ button to access the form and open it in your editing application.
2. In the 'Customer's Name' field, enter your full name as it appears on your Social Security documents.
3. Provide your 'Social Security Number' in the designated field to link the form to your records.
4. Enter the 'Name and Address of Financial Institution' that you authorize to release information.
5. If the applicant or recipient is not the customer, fill out the 'Applicant/Recipient/Beneficiary' section with the respective individual's details.
6. In the 'Account Number(s)' area, list all relevant account numbers, including those for joint accounts and direct deposits if applicable.
7. Read and understand the provided statements regarding the authorization and the implications of revoking it. Ensure that you agree with these terms.
8. Sign and date the 'Customer's Signature/Authorization' field to indicate your consent.
9. If applicable, have a legal representative sign, along with their mailing address and date.
10. For users who signed by mark (X), ensure that two witnesses provide their signatures and addresses.
11. The financial institution representative will complete the remaining sections and submit the form back to the Social Security Administration.
12. Once all information is filled out, save your changes, download a copy, print, or share the form as needed.

Complete your documents online today to ensure proper processing.