Request for Social Security Statement--Internet Version

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Information about Your Statement
Please Note:
This is your personal
Statement about your
record with Social Security.
It does not include
information about benefits
you might qualify for on
anyone else's record. To
ask about whether you
qualify on another record,
you can call our toll-free
number 1-800-772-1213
(TTY 1-800-325-0778) or
call, write or visit your local
Social Security office.

Questions about your Statement?
Your Benefits
Family Benefits
Two SSN's
Federal, State or Local Government Work
Government Pension Offset

Declaración del
Seguro Social
Get Accessible
Acrobat Reader

Windfall Elimination Provision
Military or Railroad Service
Wrong Address
Earnings, Taxes and Credits
Work Outside the U.S.
Benefits on Another Record
Name/Birthdate Wrong
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Last reviewed or modified Friday Jan 12, 2007

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Request your Social Security Statement

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Social Security Online

Request a Social Security Statement
www.socialsecurity.gov

Information about Requesting a Social Security Statement
This service is available (Eastern Time):
Monday through Friday - All Day (except 2:00 AM - 3:00 AM)
Saturday 5:00 AM - 11:00 PM
Sunday 8:00 AM - 10:00 PM
Holidays 5:00 AM - 11:00 PM
The Social Security Statement is a valuable document that estimates your future Social
Security benefits and tells you how to qualify for those benefits.
This service allows you to transmit your request for a Social Security Statement using an
online form. However, we do not send your Statement information back on the Internet.
Instead, you will receive a response to your request by U.S. mail in 2-4 weeks.
Your Social Security Statement will include:
●

●

A record of your earnings history and an estimate of how much you and your employer
paid in Social Security taxes; and
Estimates of benefits you (and your family) may be eligible for now and in the future.

To request your Social Security Statement, you will need:
●

Your name as shown on your Social Security Card

●

Your Social Security Number

●

Your date of birth

●

Your place of birth

●

Your mother's maiden name - last name only (to help identify you)

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Request your Social Security Statement

Optional:
It will help us give you better benefit estimates if you also give us:
●

Your last years' earnings and an estimate of your current and future earnings

●

Age at which you plan to stop work

Some words about security:
SSA takes numerous steps to keep your accounts and personal information secure, but you
also play a role in maintaining the security of your information. Here's what you can do:
●

●

You may not always be at your own computer when you request a Social Security
Statement. Therefore, it's important to exit your browser when you're finished so others
cannot see the information that you have entered.
We recommend you use the built-in security features Web browsers provide. Choosing
certain security settings and options will help protect the privacy of your personal
information. Security settings on your browser vary depending on whether you are using
a Netscape or Microsoft product and by version of these browsers. For more information
consult the Help files of your browser software.

Unless you have turned JavaScript off in your browser, you will receive a warning after 25
minutes and you can extend your time on the page. After the third warning, you must move to
another page, or your time will run out and your work on that page will be lost.
If you are not comfortable sending information to us on the Internet, you may download the
Social Security Statement request form (SSA-7004) and mail it to the address on the form.

Want More Information?
If you have more questions about the Internet request for a Social Security Statement, read
our Frequently Asked Questions.

Request Your Social Security Statement Now
To request a Statement using the Internet, simply select the button below and we will take you
to the Online request form. You will receive your Statement through regular mail in about 2-4
weeks.
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Request your Social Security Statement

Please Note:
If you automatically receive a Social Security Statement about three months before your
birthday each year, this request will stop your next scheduled mailing. You won't receive
another automatic Statement until the following year.

Block access to your personal information
If you want to prevent online and automated telephone access to your personal information,
you can block access to your personal information.
Request a Social Security Statement

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Request your Social Security Statement

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Social Security Online

Request a Social Security Statement
www.socialsecurity.gov

Form Approved: OMB No. 0960-0466
Expires: 7/31/2007

Please Enter Your Information
Protecting Your Information
If you are in a public place, or are otherwise concerned about others viewing your information,
we strongly advise exiting your Web browser upon completing your Statement requests. If you
use your browser BACK button, you will lose data already entered and will have to re-enter it.
If you are using only the keyboard or using an assistive device and need help, visit our
Instructional page for alternative views and navigation.
Note: If you select this link, you will leave this secure site and go to a new browser window.
You automatically will return to this page when you close the new browser window.
Instructions
Complete the following web form to submit your Statement request over the Internet. Please
do NOT mail paper copies of this web form.
All fields are mandatory unless otherwise noted. Please do not use punctuation on this
form.

Do you want to receive your statement in English or Spanish?
- Do you wish to receive your statement in English or Spanish?English
Do you wish to
receive your statement in English or Spanish?Spanish
Please type your SSN, First and Last Name, exactly as shown on your Social
Security Card.
Your Middle Initial is optional.
We cannot process your request without a valid Social Security Number.
Your SSN:
(9 numbers)
Please enter your Social Security Number without dashes. (9 numbers)
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Request your Social Security Statement

First Name:
(1 - 15 Letters)
Enter your first name. (1 - 15 Letters)
Middle Initial:
(None or 1 Letter)
OPTIONAL
Enter your middle initial.(None or 1 Letter) OPTIONAL
Last Name:
(1 - 20 Letters)
Enter your last name.(1 - 20 Letters)
Suffix:
OPTIONAL
Enter your suffix.(None or 1-4 letters) e.g. Jr, III, etc. Optional
Your Date of Birth:
Month, Day, Year
Enter Month for your date of birth

Enter Day for your date of birth

Enter

Year for your date of birth
Place of Birth:
Select state or enter name of foreign country of birth
Place of Birth:Select U.S. State or TerritoryU.S. State or Territory

Or Place of Birth:Please enter Foreign Country name.Foreign Country

Your Gender:
- Your GenderMale
Your GenderFemale
Mother's Maiden Name:
(Last name only)
(1 - 20 letters)
Mother's Maiden Name. Last name only 1 - 20 letters.
Your Telephone Number:
(All numbers: "+" allowed for foreign)
Enter the area code for the domestic phone number.U.S. (
domestic phone number.

) Enter the exchange for the

Enter the 4-digits for the domestic phone number.-

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Request your Social Security Statement

Or Or Foreign phone number.Foreign

Address Instructions:
●

●

C/O Field: If you want to have your Statement mailed to someone else, fill in the C/O
field with the name of that person.
Mailing Address: You must provide either a U.S. Mailing Address OR a Foreign
Address.
❍

❍

U.S. Street Address: Include the Street, Apartment Number, PO Box or Rural
Route.
Foreign Street Address: Include Street, City, Province and Postal Code.

U.S. or Foreign Address:
APO/FPO Military select U.S.
- U.S. or Foreign address.APO/FPO Military select US.U.S.
U.S. or Foreign address.
APO/FPO Military select US.Foreign
In Care of Name:
(1-26 letters)
OPTIONAL
Do not type "C/O" in the field below.
In Care of Name. (1-26 letters). Optional. Do not type C/O in the field below.C/O
Mailing Address:
(1-22 letters or numbers per line) Street Address (Check Instructions): For U.S. Addresses, do
NOT include
City, State, and ZIP Code
Mailing Address.(1-22 letters or numbers per line)Street Address (Check Instructions):For U.S.
Addresses, do NOT include City, State, and ZIP Code
Mailing Address.(1-22 letters or numbers per line)Street Address (Check Instructions):For U.S.
Addresses, do NOT include City, State, and ZIP Code

U.S. City: (If U.S. Address)
(1-19 letters)
U.S. City:(If U.S. Address)(1-19 letters)
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Request your Social Security Statement

State or Territory:
(If U.S. Address, select two letter state abbreviation)
If U.S. Address, select two letter state abbreviation
ZIP Code:
(If U.S. Address, 5 digit or 9 digit zip code.)
If U.S. Address, enter 5 digits ZIP
Foreign Country:
(If Foreign Address, 1-21 letters)

If U.S. Address, enter 4 digits ZIP-

If foreign country, enter 1-21 letters.
Any Other Social Security Numbers You Have Used:
(9 numbers)
OPTIONAL
Please enter any other Social Security Numbers You Have Used. (9 numbers). Optional

Please enter any other Social Security Numbers You Have Used. (9 numbers). Optional

This year's and last year's earnings:
●

●

●

●

●

Last year's earnings: Enter an EXACT or ESTIMATED amount (blank or zero amount
allowed).
This year's earnings: Enter an ESTIMATED amount (blank or zero amount allowed).
Do not include wages from State, Local or Federal Government employment that are
not covered for Social Security or that are covered only by Medicare.
Show your earnings (wages and/or net self-employment income) if covered by Social
Security.
If your earnings for any year exceeded 6 digits, enter "999999".

Last Year's Earnings:
(1 - 6 numbers)
OPTIONAL

Last Year's Earnings.(1 - 6 numbers). Optional$
This Year's Earnings:
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.00

Request your Social Security Statement

(1 - 6 numbers)
OPTIONAL
This Year's Earnings.(1 - 6 numbers). Optional$
Future Year's Earnings:
●

●

●

●

●

●

.00

Enter the average yearly amount (not your total future lifetime earnings) you think you
will earn between now and when you plan to stop working. If you expect that amount to
exceed 6 digits, enter "999999".
If you don't expect any significant changes, show the same amount you are
earning now.
Include performance or scheduled pay increases or bonuses, but NOT cost-of-living
increases.
Do not include an adjustment for inflation.
If you expect to earn significantly more or less in the future due to promotions, job
changes, part-time work, or an absence from the work force, enter the amount that most
closely reflects your future average yearly earnings.
If you show NO earnings for future years, we will estimate your benefit as if you
had zero earnings from next year on.

Future Average Yearly Earnings:
(1 - 6 numbers)
OPTIONAL
Future Average Yearly Earnings. (1 - 6 numbers). Optional$
The age you plan to stop working:

.00

●

Enter the age at which you plan to stop working, up to age 69.

●

If you do not know when you want to stop working, you can leave this field blank.

Show the age you plan to stop working:
OPTIONAL
Show the age you plan to stop working. Optional
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Request your Social Security Statement

The Privacy Act:
Social Security is allowed to collect the facts on this form under Section 205 of the Social
Security Act. We need them to quickly identify your record and prepare the Statement you
requested. Giving us these facts is voluntary. However, without them we may not be able to
give you a benefit estimate statement. The Social Security Administration will not use the
information for any other purpose.
The Paperwork Reduction Act Statement:
This information collection meets the clearance requirements of 44 U.S.C. § 3507, as
amended by section 2 of the Paperwork Reduction Act of 1995. You are not required to
answer these questions unless we display a valid Office of Management and Budget control
number. We estimate it will take you about 5 minutes to read the instructions, gather the
necessary facts, and answer the questions.
By sending this form, I certify that I am asking for action to be taken on my Social
Security record or the record of a person who has expressly authorized this request. I
understand that if I deliberately request information under false pretenses, I may be
guilty of a federal crime and could be fined and/or imprisoned.
Anyone using this system expressly consents to monitoring and is advised that if such
monitoring reveals possible evidence of criminal activity, SSA may provide the
evidence of such monitoring to law enforcement officials.
SELECT AN ACTION BELOW
Select one of the options.
Continue
Cancel

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Request your Social Security Statement
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Social Security Online

Request a Social Security Statement
www.socialsecurity.gov

Thank You
Social Security has received and is processing your information. You will receive a statement
by mail in about 4 weeks.
By sending this form, I certify that I am asking for action to be taken on my Social
Security record or the record of a person who has expressly authorized this request. I
understand that if I deliberately request information under false pretenses, I may be
guilty of a federal crime and could be fined and/or imprisoned.
Anyone using this system expressly consents to monitoring and is advised that if such
monitoring reveals possible evidence of criminal activity, SSA may provide the
evidence of such monitoring to law enforcement officials.
SELECT AN ACTION BELOW
Select the "Request Another Statement" button to request another Statement by
mail or select "Done".
Request Another Statement

Done

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