SSA-85 - Current

Form SSA-85 (10-2018)
Discontinue Prior Editions
Social Security Administration

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OMB No. 0960-0189

INFORMATION NEEDED TO REVIEW YOUR SOCIAL SECURITY CLAIM
Claim Number: XXX-XXPlease have documents or proof of the ITEMS CHECKED below available for your interview if you have them in your possession.
This will help us complete the review of your claim more quickly. Information regarding any items that are not checked but may
pertain to you should also be mentioned during the interview. With the exception of W-2 forms and tax returns, we must see
the original document or a copy certified by the custodian of the record or by a representative in your local Social
Security office.
Social Security or Medicare card for
Birth or baptismal certificate recorded before you were age 5 - otherwise, at least two of the following documents are
needed: school records, census records, delayed birth certificate, children's birth certificates, family bible, naturalization
certificate, etc.
Records of age will also be needed for
Marriage certificates for you and
Divorce or annulment decrees for all prior marriages
Death certificates for
Social Security numbers for all former spouses
Proof of military service
Pay slips or W-2 forms for
Self-employment tax returns for
A copy of the earnings record for the account on which you are receiving benefits is enclosed. Please review the earnings
and compare them with your records. I have highlighted some specific years that I would like to discuss with you.
If you disagree with any of these earnings, please have your records available at the time of the interview. W2 forms are the
best evidence of wages. Tax returns and proof of filing are the best evidence of self-employment income.
Other

Form SSA-85 (10-2018)

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Privacy Act Statement
Collection and Use of Personal Information
Sections 205(a), 228(a), 1614(a) and 1836 of the Social Security Act, as amended, allow us to collect this information.
Furnishing us this information is voluntary. However, failing to provide all or part of the information may prevent us from making
an accurate and timely decision on your claim.
We will use the information to review your claim. We may also share your information for the following purposes, called routine
uses:
1. To third party contacts in situations where the party to be contacted has, or is expected to have, information relating to the
individual's capability to manager their affairs or eligibility for or entitlement to benefits under the Social Security program
when the data are needed to establish the validity of evidence or to verify the accuracy of information presented by the
individual; and
2. To applicants, claimants, prospective applicants or claimants, other than the data subject, their authorized representatives or
representative payees to the extent necessary to pursue Social Security claims and to representative payees when the
information pertains to individuals for whom they serve as representative payees, for the purpose of assisting SSA in
administering its representative payment responsibilities under the Act and assisting the representative payees in
performing their duties as payees, including receiving and accounting for benefits for individuals for whom they serve as
payees.
In addition, we may share this information in accordance with the Privacy Act and other Federal laws. For example, where
authorized, we may use and disclose this information in computer matching programs, in which our records are compared with
other records to establish or verify a person's eligibility for Federal benefit programs and for repayment of incorrect or delinquent
debts under these programs.
A list of additional routine uses is available in our Privacy Act System of Records Notice (SORN) 60-0089, entitled Claims
Folders Systems. Additional information and a full listing of all our SORNs are available on our website at
www.socialsecurity.gov/foia/bluebook.