$30.00 for certified yearly earnings totals; $92.00 for a non-certified detailed (itemized) earnings statement; and. A Form SSA 7050 is known as a Request for Social Security Earnings Information. 1. FEMA and State Resources for Hurricane Ian. 589 0 obj <>/Encrypt 581 0 R/Filter/FlateDecode/ID[]/Index[580 25]/Info 579 0 R/Length 62/Prev 94611/Root 582 0 R/Size 605/Type/XRef/W[1 2 1]>>stream Request for Social Security Earnings Information (Form SSA-7050). All forms are FREE. It is useful for people of all ages who want to learn about their future Social Security benefits and current earnings history. If you can't find the form you need, or you need help completing a form, please call us at 1-800-772-1213 (TTY 1-800-325-0778) or contact your local Social Security office and we will help you. FEMA and State Resources for Hurricane Ian. Comply with our simple steps to get your Request For Social Security Earnings InformationRequest For Social Security Earnings well prepared quickly: Select the template from the catalogue. Certified/Non-Certified Detailed Earnings Information Includes periods of employment or self-employment and the names and addresses of employers. 1. 0960-0525 REQUEST FOR SOCIAL SECURITY EARNING INFORMATION *Use This Form If You Need 1. Effective October 01, 2020, the Social Security Administration (SSA) will only accept this version of the Request for Earnings Information (Form SSA-7050-F4) due to an increase in the standard fees. REQUEST FOR SOCIAL SECURITY EARNING INFORMATION . Provide your name as it appears on your most recent Social Security card or the name of the individual whose earnings you are requesting. REQUEST FOR SOCIAL SECURITY EARNING INFORMATION . OR 2. REQUEST FOR SOCIAL SECURITY EARNING INFORMATION . Date of Death: Other Name(s) Used 1. It is in social security benefits. It is useful for people of all ages who want to learn about their future Social Security benefits and current earnings history. Views: 101230 If you do not require certification or an itemized earnings statement, your yearly earnings totals are free. Your Social Security number as shown on your card: - - 3. OR 2. A Form SSA 7050 is known as a Request for Social Security Earnings Information. Visit our website to obtain your free yearly totals of earnings. REQUEST FOR SOCIAL SECURITY EARNINGS INFORMATION. Effective October 01, 2020, the Social Security Administration (SSA) will only accept this version of the Request for Earnings Information ( Form SSA-7050-F4) due to an increase in the standard fees. Social Security Administration. Date of Birth: Other Name(s) Used Certified Yearly Totals of Earnings First Name: Middle Initial:Last Name: Social Security Number (SSN) One SSN per request Date of Birth: Date of Death: Other Name(s) Used Maiden Name. The user-friendly drag&drop interface allows you to add or move areas. The Request for Social Security Earnings Information form is an official form that can be used to request data on how much an individual has earned. Certified Yearly Totals of Earnings 2. These PDFs may not function consistently/as intended while both filling it out and using a screen reader. OR 2. Youre offline. Section 205 of the Social Security Act, as amended, authorizes us to collect the information on this form. 1 . For workers age 60 and older who do not have a my Social Security account, we currently mail Social Security Statements three months prior to your birthday. 0960-0525 *Use This Form If You Need. You can preview it now and share your feedback. It will be helpful to have information such as Forms W-2, pay stubs, etc. Includes periods of employment or self-employment and the names and addresses of employers. FEMA and State Resources for Hurricane Ian. This website is produced and published at U.S. taxpayer expense. Resources https://www.socialsecurity.gov/forms/ssa-7050.pdf %PDF-1.7 % All forms are FREE. 0960-0525. We will launch a new website. This website is produced and published at U.S. taxpayer expense. This form is used to request more detailed information about your yearly earnings that contributed to your social security benefits and retirements amount. 2. First Name: Middle Initial:Last Name: Social Security Number (SSN) One SSN per request Date of Birth: Date of Death: Other Name(s) Used Maiden Name. Includes total earnings for each year but does not include the names and addresses of employers. 1. Or, call SSA's main number at 1-800-772-1213 (TTY 1-800-325-0778) to make the report. yS%X` K\dNa9n\9t\9rXbo0bP3\#PYrqz|dSd67}q'2A^wsQ5"6\sOqb@f8)SSvfHG6F~ Your date of birth / / 4. We will launch a new website. 580 0 obj <> endobj Certified/ on-Certified Detailed Information Includes periods of employment or self-employment and the names addresses of employers. We will launch a new website. hbbd``b`fo3H0UK# 2012 )" Tk Form SSA-7050-F4 (01-2014) EF (01-2014) First Name: Middle Initial: Last Name: Social Security Number (SSN) One SSN per request. Make sure the data you fill in OMB No. endstream endobj startxref 2. Your Social Security Statement (Statement) is available to view online by opening a my Social Security account. Provide your name as it appears on your most recent Social Security card or the name of the individual whose earnings you are requesting. To report a death: Provide the deceased person's Social Security number to the funeral director so they can report the death to the SSA. REQUEST FOR SOCIAL SECURITY EARNING INFORMATION . REQUEST FOR SOCIAL SECURITY EARNINGS INFORMATION. First Name: Middle Initial:Last Name: Social Security Number (SSN) One SSN per request Date of Birth: Date of Death: Other Name(s) Used Maiden Name. REQUEST FOR SOCIAL SECURITY EARNINGS INFORMATION Form Approved OMB No. Provide your name as it appears on your most recent Social Security card or the name of the individual whose earnings you are requesting. DEQY The DEQY displays requested earnings information and related data. Provide your name as it appears on your most recent Social Security card or the name of the individual whose earnings you are requesting. OMB No. They can help you better understand Social Security programs and benefits. DO NOT USE THIS FORM FOR: Your online Social Security Statement displays uncertified yearly earnings free of charge and does not show any employer information. 1. This website is produced and published at U.S. taxpayer expense. Your Social Security Statement (Statement) is available to view online by opening a my Social Security account. Background. Certified/Non-Certified Detailed Earnings Information. Form Approved OMB No. 1. For the best experience, open PDFs in Adobe Reader (free download). Fill out the form below to learn how our Forms Workflow solution can streamline your firm. Social Security Administration. The fact sheets are designed to provide clarity and useful information, based on your age group and earnings situation. 0960-0525 *Use This Form If You Need. 1. REQUEST FOR SOCIAL SECURITY EARNINGS INFORMATION OMB No. completed the form, mail it to: Social Security Administration Wilkes Barre Direct Operations Center P.O. 2. OR. 2. Your personal Statement may include different language, depending on your situation. We will use the information you provide to identify your records and send the . 2. If you can't find the form you need, or you need help completing a form, please call us at 1-800-772-1213 (TTY 1-800-325-0778) or contact your local Social Security office and we will help you. Check each area has been filled in . Statement for People with Noncovered Earnings, Retirement Ready (Fact Sheet For Workers Ages 18-48), Retirement Ready (Fact Sheet For Workers Ages 49-60), Retirement Ready (Fact Sheet For Workers Ages 61-69), Retirement Ready (Fact Sheet For Workers Ages 70 and Up), Additional Work Can Increase Your Future Benefits, You Have Earnings Not Covered By Social Security, Supplemental Security Income And Other Benefits. 2. Certified/Non-Certified Detailed Earnings Information. First Name: Middle Initial:Last Name: Social Security Number (SSN) One SSN per request Date of Birth: Date of Death: Other Name(s) Used Maiden Name. You can find 3 options; typing, drawing, or capturing one. How to Report a Death to Social Security. If you do not require certification or an itemized earnings statement, your yearly earnings totals are free. contact your local Social Security office, request a replacement Social Security card online, Authorization to Disclose Information to the Social Security Administration, Application for Enrollment in Medicare - Part B (Medical Insurance), SOLICITUD PARA RETIRAR UNA PETICIN PARA REVISIN CON EL CONSEJO DE APELACIONES, Request for Hearing by Administrative Law Judge, Waiver of Timely Written Notice of Hearing, Renuncia a la notificacin escrita oportuna de la audiencia, Request for Review of Hearing Decision/Order, Notice Regarding Substitution of Party Upon Death of Claimant, Aviso Sobre La Substitucin De La Parte Interesada Tras El Fallecimiento Del Reclamante, Waiver of Your Right to Personal Appearance Before an Administrative Law Judge, Application for Employer Identification Number, Apply for Retirement, Spouse's or Medicare Benefits, Apply Online for Extra Help with Medicare Prescription Drug Plan Costs, Request a Form SSA-1099/1042 (Benefit Statement) for tax or other purposes, Request a Proof of Social Security Benefits Letter, Request Special Notices for the Blind or Visually Impaired, Application for a Social Security Card (Outside of the U.S.), Solicitud para una tarjeta de Seguro Social, Application for Retirement Insurance Benefits, Solicitud Para Beneficios De Seguro Por Jubliacin, Application for Wife's or Husband's Insurance Benefits, Solicitud Para Beneficios De Seguro Como Cnyuge, Application for Child's Insurance Benefits, Solicitud Para Beneficios De Seguro Para Nios, Reporting Responsibilities for Child's Insurance Benefits, Application for Mother's or Father's Insurance Benefits, Application For Mother's Or Father's Insurance Benefits - Spanish, Reporting Responsibilities for Mother's or Father's Insurance Benefits, Application for Parent's Insurance Benefits, Application for Parent's Insurance Benefits - Spanish, Application for Widow's or Widower's Insurance Benefits, Reporting Responsibilities for Widow's or Widower's Insurance Benefits, Solicitud Para Beneficios de Seguro como Cnyuge Sobreviviente, Application for Disability Insurance Benefits, Solicitud para beneficios de seguro por incapacidad, Supplement to Claim of Person Outside the United States, Application for Survivors Benefits (Payable Under Title II of the Social Security Act), Certification of Election for Reduced Spouse's Benefits, Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event, Pre-Approval Form for Consent Based Social Security Number Verification (CBSV), Authorization for the Social Security Administration To Release Social Security Number (SSN) Verification, Autorizacin para que la Administracin de Seguro Social Divulgue la Verificacin de un Nmero de Seguro Social (SSN), Waiver of Supplemental Security Income Payment Continuation, Modified Benefits Formula Questionnaire, Foreign Pension, Complaint Form for Allegations of Discrimination in Programs or Activities Conducted by the Social Security Administration, Formulario Para Querellas De Alegaciones De Discriminacin En Los Programas De La Administracin Del Seguro Social, Worker's Compensation/Public Disability Questionnaire, Request for Waiver of Overpayment Recovery, Request for Change in Overpayment Recovery Rate, Solicitud de cambio en la tasa de recuperacin de sobrepago, Financial Disclosure for Civil Monetary Penatly (CMP) Debt, Request for Deceased Individual's Social Security Record, Notice to Electronic Information Exchange Partners to Provide Contractor List, Request for Change in Time/Place of Disability Hearing, Notice Regarding Substitution of Party Upon Death of Claimant Reconsideration of Disability Cessation, Waiver Of Right To Appear - Disability Hearing, Certificate of Responsibility for Welfare and Care of Child, Statement of Care and Responsibility for Beneficiary, Request for Reconsideration - Disability Cessation, Work Activity Report (Self-Employed Person), Instrucciones para completar el formulario SSA-827, General Instructions for Completing the Application for Extra Help with Medicare Prescription Drug Plan Costs, Appeal of Determination for Extra Help with Medicare Prescription Drug Plan Costs, Apelacin de la determinacin para recibir el Beneficio Adicional con los gastos del plan de medicamentos recetados de Medicare, Instructions for Completing the Appeal of Determination for Extra Help with Medicare Prescription Drug Plan Costs, Instrucciones para llenar la apelacin de la determinacin para recibir el beneficio adicional con los gastos del plan de medicamentos recetados de Medicare, Advanced Notice of Termination of Child's Benefits, Advanced Notice of Termination of Child's Benefits (Foreign Claims), Adviso Por Adelantado De Cese De Beneficios Para Nios, Reporting to Social Security Administration by Student Outside the United States, Petition For Authorization To Charge And Collect A Fee For Services Before The Social Security Administration, Eligible Non-Attorney Representative Application, Fee Agreement for Representation Before the Social Security Administration, Request for Business Entity Taxpayer Information, Claimant's Revocation of the Appointment of a Representative, Representative's Withdrawal of Acceptance of Appointment, Registration for Appointed Representative Services and Direct Payment, Claim for Amounts due in case of a Deceased Beneficiary, Statement Concerning Your Employment in a Job Not Covered by Social Security, Statement for Determining Continuing Entitlement for Special Veterans Benefits (SVB), Request for Waiver of Special Veterans Benefits (SVB) Overpayment Recovery or Change in Repayment Rate, Pre-1957 Military Service Federal Benefit Questionnaire, Important information about your appeal, waiver rights, and repayment options, Function Report - Child Birth to 1st Birthday, Function Report - Child Age 1 to 3rd Birthday, Function Report - Child Age 3 to 6th Birthday, Function Report - Child Age 6 to 12th Birthday, Function Report - Child Age 12 to 18th Birthday, Function Report - Adult - Third Party Form, Questionnaire for Children Claiming SSI Benefits, Certification of Election for Reduced Widow(er)'s and Surviving Divorced Spouse's Benefits, Medical Report on Adult with Allegation of Human Immunodeficiency Virus (HIV) Infection, Medical Report on Child with Allegation of Human Immunodeficiency Virus (HIV) Infection, Claimant's Statement about Loan of Food or Shelter, Cuestionario para Maestros (Teacher Questionnaire), Solicitud para un Estado de cuenta del Seguro Social, Request for Correction of Earnings Record, Request for Social Security Earnings Information, Questionnaire about Employment or Self Employment, Supplemental Statement Regarding Farming Activities, Authorization for the Social Security Administration to Obtain Wage and Employment Information from Payroll Data Providers, Authorization for the Social Security Administration to Obtain Personal Information, Medicare Savings Programs Eligible Letters, Cartas para saber si tiene derecho al Programa de ahorros de Medicare. You can also get the statement certified by the SSA for an additional fee. 1. Certified yearly earnings totals or an itemized earnings statement (certified or non-certified) can be obtained by completing the Request for Social Security Earnings Information (Form SSA-7050). If you download, print and complete a paper form, please mail or take it to your local Social Security office or the office that requested it from you. 1. is updated and correct. Also, it is who is currently collecting social security benefits. Form SSA-7050-F4 (03-2019) Discontinue Prior Editions Social Security AdministrationPage 1 of 4 OMB No. Form Approved OMB No. For workers age 60 and older who do not have a my Social Security account, we currently mail Social Security Statements three months prior to your birthday. This is a read only version of the page. Form SSA-7050-F4 (02-2021) Discontinue Prior Editions Social Security Administration. Provide your name as it appears on your most recent Social Security card or the name of the individual whose earnings you are requesting. Mail postmarked after October 01, 2020 containing older versions of the Form SSA-7050 or an incorrect fee will be returned to the requestor unprocessed. The Social Security Administration charges a small fee for detailed information based on the length of time for which you would like to receive records. Includes periods of employment or self-employment and the names and addresses of employers. This form will require your personal identifying information, including social security information. We redesigned the Statement to make it easier for you to read and find the information you need! When speaking to an agent you can ask for the form to request your earning records to be mailed to you or you could ask if you have the option of completing the request over the phone. You will receive detailed information about your work history including employment dates, employer names and addresses, and earnings. Provide your name as it appears on your most recent Social Security card or the name of the individual whose earnings you are requesting. 0960-0525 *Use This Form If You Need. 0960-0525 REQUEST FOR SOCIAL SECURITY EARNINGS . For instructions concerning the handling of access requests, see GN 03340.000. . REQUEST FOR SOCIAL SECURITY EARNINGS INFORMATION. Complete all necessary information in the necessary fillable areas. Forms. Forms SSA-7014, Social Security Administration Earnings Record Information, are letter forms produced by the Personal Earnings and Benefit Estimate System (PEBES) in certain situations in response to requests for a Social Security Statement.The five versions of this form are part of SSA's Target Notice Architecture database. Contact your local Social Security office. do not allow PDFs to open/display properly within the browser. Includes periods of employment or self-employment and the names and addresses of employers. Name shown on your Social Security card: First Name: Middle Initial: Last Name only: 2. request Form SSA-7004, Request for Earnings and Benefit Estimate Statement) 3. Call 1-800-772-1213 or TTY number, 1-800-325-0778. You can find a location close to you by searching your zip code in this locator. You can preview it now and share your feedback. Provide your name as it appears on your most recent Social Security card or the name of the individual whose earnings you are requesting. Certified/Non-Certified Detailed Earnings Information Includes periods of employment or self-employment and the names and addresses of employers. 1. endstream endobj 581 0 obj <>>>/EncryptMetadata false/Filter/Standard/Length 128/O(-Bh?v^4)/P -1052/R 4/StmF/StdCF/StrF/StdCF/U(%=m0?> )/V 4>> endobj 582 0 obj <>/Metadata 69 0 R/Names 591 0 R/Pages 578 0 R/Permsstream Certified yearly earnings totals or an itemized earnings statement (certified or non-certified) can be obtained by completing the Request for Social Security Earnings Information (Form SSA-7050). REQUEST FOR SOCIAL SECURITY EARNINGS INFORMATION. 0960-0525. Not all forms are listed. 20 CFR 404.810, 20 CFR 401.100. Most modern browsers (Microsoft Edge, Google Chrome, etc.) 1. To request detailed record information, including identification of employers, an individual may complete the Request for Social Security Earnings Information form SSA-7050-F4. . Include wages reported by an employer as paid to an individual, but not shown in our records. REQUEST FOR SOCIAL SECURITY EARNINGS INFORMATION. If you owe us a fee for this detailed earnings information, enter the amount due . Certified/Non-Certified Detailed Earnings Information . Certified/Non-Certified Detailed Earnings Information. With a my Social Security account, you may be able to correct your Social Security earnings record online, but you can also contact us at 1-800-772-1213 (TTY 1-800-325-0778 ). Important Note: PDFs you open from this page may default to opening within a browser, depending on your browser settings. We have added new fact sheets to accompany the Statement. %%EOF The form is also to verify the information. FEMA and State Resources for Hurricane Ian. REQUEST FOR SOCIAL SECURITY EARNINGS INFORMATION. Include the date to the document using the Date function. Page 1 of 4 OMB No. Form Approved OMB No. Certified/Non-Certified Detailed Earnings Information . Form SSA-7050-F4. This form is used by government officials, as well as by those who are requesting benefits. Thank you! Includes periods of employment or self-employment and the names and addresses of employers. OR 2. , Certified Yearly Totals of Earnings Includes total earnings for each year but does not include the names and addresses of employers. We will launch a new website. The redesigned Statement now includes a bar graph displaying your personalized retirement benefit estimates at nine different ages, depending on when you want benefits to start. You can view your personal Social Security Statement online by creating a my Social Security account with us. $122.00 for a certified detailed (itemized) earnings statement. 1. REQUEST FOR SOCIAL SECURITY EARNING INFORMATION . Certified Yearly Totals of Earnings Includes total earnings for each year but does not Requests for Social Security Earnings Information. This form should be sent to the Social Security Administration in order to request a statement. We encourage you to review your Statement annually. To sign in or create an account, go to www.socialsecurity.gov/myaccount. Form SSA-7050-F4 (11-2014) EF (11-2014) First Name: Middle Initial: Last Name: Social Security Number (SSN) One SSN per request. Other Social Security numbers you have used: - - - - Available Monday - Friday 7:00 AM to 6:00 PM Pacific time (excluding major holidays) Phone: 800-293-2771 It also includes your earnings history, and information on how to report an error if you find one. Certified Yearly Totals of Earnings. If you download, print and complete a paper form, please mail or take it to your local Social Security office or the office that requested it from you. Not all forms are listed. REQUEST FOR SOCIAL SECURITY EARNINGS INFORMATION. Social Security Statement. I understand that any false representation to knowingly and willfully obtain information from Social Security records is punishable by a fine of not more than $5,000 or one year in . Box 7004 Wilkes Barre, PA 18767-7004. This form is used to request more detailed information about your yearly earnings that contributed to your social security benefits and retirements amount. REQUEST FOR SOCIAL SECURITY EARNING INFORMATION *Use This Form If You Need . 0960-0525. 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