Social Security Administration Consent for Release of Information Form (SSA 3288)

A Social Security Administration Consent for Release of Information Form (or SSA 3288, or social security administration authorization form) is a document that you should complete to allow some people and organizations to get personal information about yourself.

Typically, among these people and organizations are:

  • Doctors
  • Medical services’ representatives
  • Insurance companies

You must complete the release of liability form attentively because skipping the blank fields or writing incorrect details may cause problems.

Each SSA consent for release of information contains specific details, including:

  • Informative notice that explains basic terms
  • The name of the applicant whose information may be accessed
  • Reasons for releasing the information
  • The applicant’s contact and personal details

For the validity of the SSA 3288 form, you have to ask two witnesses to sign the paper.

It is typical to use this form when you (or a minor or an incompetent adult you take care of) are applying to receive financial or medical support.

For instance, if you need to obtain an electric wheelchair, the responsible institution must access specific information to issue one. They need an SSA 3288 form signed by an applicant to access such data.

SSA 3288 Form Details

Document Name SSA 3288 Form
Other Names Social Security Administration Authorization, Social Security Medical Release
Avg. Time to Fill Out 13 minutes
# of Fillable Fields 40
Available Formats Adobe PDF
  • Define Why You Are Creating This Document. Because you will have to state the reasons for completing the SSA 3288 form clearly, you should understand why you need a particular institution to access your data.
  • List Organizations That May Access Your Data. You have to name all institutions that are allowed to access your personal information.
  • Learn the Basics. When creating the form, you should be aware of the regulations and conditions. To clarify everything, you will have to read the notice at the beginning of the form.
  • Sign and File the Document. Without your signature, no company or institution can access the data. Ensure that you have signed and filed the SSA 3288 form (or social security administration consent for release of information form, or social security administration authorization form).
Template Preview
Download your fillable Child Medical Consent Release template in PDF.

To make everything easier, we have prepared a detailed guide to help you complete the SSA 3288 form.

 Download the Template

You should begin by downloading the correct template of the SSA 3288 form. To speed the process up, use our form-building software.

Read the Instructions

As we have mentioned before, the SSA 3288 form suggests you read the basic instructions and rules that regulate the creation of such a document. Read the whole text carefully. If something is still unclear, you may contact your lawyer and ask questions.

Enter Your Information

In the suitable blank lines, add your name, date of birth, and social security number (or SSN).
Step 3 to filling out a SSA 3288 form information

Name the Institutions or Individuals

Below your information, list organizations, or people who may access your data. Place the names on the left-hand side and the addresses on the right.
Step 4 to filling out a SSA 3288 sample names

Describe the Reasons

Then, describe why you want your information disclosed to those institutions (or people).

Choose the Data to Disclose

You will see a list of items that may be revealed to the chosen parties. Opt for suitable items.
Step 6 to filling out a SSA 3288 sample disclosure data

Sign the Form

Insert the date of signing, your address, and your telephone number. Sign the paper and ask two witnesses to sign, too.
Step 7 to filling out a SSA 3288 template signatures

Published: Jun 29, 2022