Get Form Ssa-437-bk 2009-2025

Filling out the Form SSA-437-BK online is an important step for users wishing to file a complaint regarding allegations of program discrimination by the Social Security Administration. This guide will assist users through each section of the form to ensure that all necessary information is provided clearly and accurately.

Follow the steps to successfully complete the Form SSA-437-BK online.

1. Click the ‘Get Form’ button to obtain the form. This will open the form in your online editor, allowing you to begin filling it out.
2. In the first section, enter your full name, address, and Social Security number. Make sure to provide accurate contact information for any future correspondence.
3. If the person allegedly discriminated against is different from you, fill out their name and contact information in the designated fields.
4. Explain your relationship to the person identified in the previous question. Provide any necessary details that clarify your connection.
5. Indicate the basis of the alleged discrimination, selecting from categories such as race, color, national origin, religion, sex, disability, age, or parental status.
6. Provide the date(s) on which the alleged discrimination took place, ensuring that this is within the 180-day filing deadline.
7. Describe the actions taken by SSA that you believe were discriminatory. Include details about any witnesses and the location where the action took place.
8. If you experienced retaliation for filing or participating in a previous complaint, explain the circumstances and actions that led to this retaliation.
9. List any witnesses who may have additional information about the complaint. Provide their contact details for follow-up, if necessary.
10. Detail any communications you had with SSA officials regarding the supposed discriminatory actions, including names and dates.
11. Clearly state what resolution or action you are seeking from SSA as a result of your complaint.
12. Indicate whether a complaint has been filed with any other agency regarding this matter and provide relevant details.
13. Explain how you learned about the option to file a complaint using this form.
14. Lastly, ensure you sign and date the form before submission. If someone else is filing on your behalf, obtain their signature as well.
15. Once completed, save your changes, and you can download, print, or share the form as necessary. Remember to send the signed complaint to the specified SSA office via mail, fax, or email.

Take action now and complete the Form SSA-437-BK online to ensure your complaint is filed accurately and promptly.