Current Internet SSA-711

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Social Security Online
Electronic Freedom of Information Act
www.socialsecurity.gov

Request for Deceased Individual's Social
Security Record
Form SSA-711 Internet Request
Form Approved: OMB No. 0960-0665
Expiration Date: 11/30/2012

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For information on how to complete this form, follow the form instructions.

Request Type and Fee
Photocopy of Original Application for a Social Security Card (SS-5)
$27.00, SSN of deceased individual is provided
$29.00, SSN of deceased individual is not provided

Computer Extract of Social Security Card Application
$16.00, SSN of deceased individual is provided
$18.00, SSN of deceased individual is not provided
Certification is required, adds $10.00 to fee

Deceased Individual's Information
We use the "120 year rule" when disclosing information from our records for extremely aged
persons when no date of death exists. We normally do not assume that an individual is
deceased without proof of death (e.g., death certificate, obituary, newspaper article, or police
report).
Also, under our current policy, we do not release the parents' names unless they are proven

deceased, have a birth date more than 120 years ago, or the number holder on the SS-5 is at
least 100 years of age.

Name of individual at birth

First

Middle

Last

Name(s) of individual (if other than above/other name(s) used)

Social Security Number

Date of birth

Month

Day

Year

Sex
Male

Female

Deceased Individual's Parents' Information

Mother's maiden name

First

Middle

Last

Mother's married name(s)

Father's name

First

Middle

Last

Requester's Information

Name

First

Middle

Last

Address

Street Address 1
Street Address 2
City

State

Zip
-

Telephone

Fax

E-mail

Cancel

Submit

PAPERWORK REDUCTION And PRIVACY ACT STATEMENT
Privacy Policy | Website Policies & Other Important Information |
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PAPERWORK REDUCTION And PRIVACY ACT STATEMENT

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Electronic Freedom ofInformation Act

www.socialsecurity.gov

PAPERWORK REDUCTION And
PRIVACY ACT STATEMENT

PAPERWORK REDUCTION ACT STATEMENT
This infonnation 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 that it will take you about 3 minutes to read
the instructions, gather the necessary facts, and answer the
questions. You may send comments on our time estimate above to:
SSA, 6401 Security Blvd., Baltimore, MD 21235-6401. Send only
comments relating to our time estimate to this address, not the
completed form.

PRIVACY ACT STATEMENT

Collection and Use of Personal Information

Section 205 of the Social Security Act, as amended; the
Government Paperwork Elimination Act (P.L. 105-277); and the
Federal Infonnation Security Management Act of 2002 (Title III) of
the E-Government Act of2002 (P.L. 107-347) authorize us to
collect this infonnation to pennit access to our online applications.
We need this infonnation to quickly identifY you, locate the records
you are requesting, and provide you with a response.
Your responses are voluntary. Without the infonnation, however,
we will not be able to process your request.
We rarely use the infonnation you give us for any purpose other
than to process your Freedom of Infonnation Act request. However,
we may use it for the administration and integrity of Social Security
programs. We may also disclose infonnation to another person or to
another agency in accordance with approved routine uses, which
include, but are not limited to, the following:
I. To comply with Federal laws requiring the release of

infonnation from Social Security records (e.g. to the

Government Accountability Office and Department of

Veterans Affairs);

2. To respond to a request on your behalf from a Congressional
office or the Office of the President;
3. To facilitate statistical research, audit, or investigative
activities necessary to assure the integrity and improvement of

https:llsecure.ssa.gov/apps9/eFOIA-FE Web/intemetlmain.j sp ?action=Privacy

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PAPERWORK REDUCTION And PRIVACY ACT STATEMENT

Social Security programs;
4. To other Federal agencies and our contractors, including

external data sources, to assist us in efficiently administering

our programs.

A complete list of routine uses for this information is available in

our Privacy Act System of Records Notice (SORN) entitled,

Electronic Freedom of Information Act (e-FOIA) System (60­
0340). The complete SORN text, additional information about this

application, and other information about our programs are available

online at www.socialsccurity.gov or at your local Social Security

office. If you want to learn more about the reasons why we use or

share the information you give us, contact any of our local offices.

Privacy Policy I Website Policies & Other Important
Infonnation I Site Map

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6/7/2012