Get Form Ssa-437-bk 2013-2025

Filling out the Form SSA-437-BK is an essential step in submitting a complaint regarding discrimination within Social Security Administration programs. This guide provides detailed instructions on completing each section of the form online, ensuring a clear and supportive process for users.

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

1. Click the ‘Get Form’ button to obtain the form and open it in your online editor.
2. In the first section, provide your name, address, and Social Security number. Ensure this information is accurate to facilitate communication regarding your complaint.
3. If the person who experienced discrimination is different from you, fill out their information in the next section, including their name, address, and contact number.
4. Explain your relationship to the individual identified in step 2, if applicable.
5. In the subsequent section, clearly specify the basis or bases on which you believe discrimination occurred, referencing the categories provided such as race, color, national origin, religion, sex, disability, age, and parental status.
6. Indicate the date(s) when the alleged discrimination took place to establish a timeline.
7. If the discrimination occurred more than 180 days ago, provide an explanation as to why you are filing your complaint late.
8. Describe in detail the actions taken by SSA that you believe were discriminatory. Provide specific names, locations, and any documented evidence to support your claims.
9. If applicable, explain any instances of retaliation you experienced as a result of prior discrimination complaints.
10. List the names and contact information of any witnesses who may provide additional insight regarding your complaint.
11. Detail any previous communications with SSA officials about the alleged discrimination, including who you spoke to and what the interactions entailed.
12. Clearly state the outcome or remedy you are seeking from SSA as a result of your complaint.
13. Indicate if you have filed a complaint regarding this issue with any other agency or organization and provide relevant details.
14. Finally, remember to sign and date the form to authenticate your complaint. If you are submitting for someone else, ensure their signature is also included.
15. After reviewing your completed form, save changes as needed, then download, print, or share the form as desired.

Take the first step toward addressing your concerns by completing the Form SSA-437-BK online today.