Send or bring the completed form to your local Social Security office.
Unknown: All items on this form requiring an answer must be answered or marked “Unknown.”
More space: If you need more space for explaining any answers to the questions, attach a separate sheet.
Other than cash: If other than cash was contributed, such as clothing, board or room, give the following information regarding items supplied.
Witnesses: Witnesses are required only if this statement has been signed by mark (X).
| Question | Answer |
|---|---|
| Form Name | Form SSA-783 |
| Form Length | 3 pages |
| Fillable? | Yes |
| Fillable fields | 75 |
| Avg. time to fill out | 13 min |
| Other names | SSA-783, SSA783, SSA 783, Form SSA-783, Statement Regarding Contributions |
| Edition | 09-2026 |
| Issuing agency | Social Security Administration |
| Where to send | Your local Social Security office |
| Who signs | Person making statement |
| Official source | Form SSA-783 (Rev 09-2026), Social Security Administration |
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