Form Ssa 2853 PDF Details

Form Ssa-2853 is a form that is used to request records from the Social Security Administration (SSA). The form can be used to request records for yourself, another person, or a deceased individual. The requested records may include: Social Security earnings statements, benefit verification letters, and Medicare entitlement information. The form must be completed and signed by the person requesting the records, and must be accompanied by a copy of his or her valid photo identification. Completed forms should be mailed to the address listed on the form.

QuestionAnswer
Form NameForm Ssa 2853
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesssa 2853 op3 sp, ssa 2853, ssa 2853 pdf, ssa 2853 form

Form Preview Example

MESSAGE FROM SOCIAL SECURITY

INFORMATION ABOUT WHEN YOU WILL RECEIVE

YOUR BABY'S SOCIAL SECURITY CARD

IMPORTANT: IF YOU HAVE NOT NAMED YOUR BABY, WE CANNOT ISSUE A SOCIAL SECURITY CARD

You should get your baby's Social Security card in about 3 weeks. It takes your State about 2 weeks to notify the Social Security Administration (SSA) about your baby's birth. After the birth is registered, SSA will issue your baby a Social Security number. The card will be mailed to you about one week after SSA is notified by the State of your baby's birth. Check with your local postal authorities about mailbox name requirements to ensure delivery.

Never pay a fee to get a Social Security card. If anyone asks for money to help you get a card, notify SSA immediately at 1-800-772-1213.

If your baby has medical problems, call SSA at the number shown above to find out if Supplemental Security Income (SSI) can help. If you receive Social Security benefits, call the number shown above to find out if your baby may be eligible to receive benefits on your account.

If you are filing for Welfare or other public assistance benefits for your baby, you will need the following information completed before you leave the hospital.

This certifies that a Social Security number was requested for

Name of Child

Signature of hospital official

Date

NOTE: Notify your caseworker when you receive your baby's card.

Form SSA-2853-OP2 (08-2009) Destroy Prior Editions

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