SSA-L707 Current Version

Form Approved
OMB No. 0960-0766

Social Security Administration

Request For Proof(s) From Custodian of Records
Date:

Unit Number:
To: Custodian of Records
Address
Address
City

State

ZIP Code

• Please furnish a certified copy of your record or Letter of No Record of the following event(s):
Marriage
Divorce
Death
• Verification of Requester's Identity (if required)
Proof of the requester's identity is attached.
• The document is needed for Social Security Administration purposes.
• Enclosed is $

in the form of:

Personal Check
Certified Check
Money Order
Credit Card (Type, Number, Expiration Date, Name as shown on the card)
Other (specify)
No Fee Required
Do Not Send Cash
• Please send the document(s) to (check one):
The Social Security Office
(Please Print)
Social Security Administration
Attention:

OR

My address below
(Please Print)
Name:

Address

Address

Address

Address

City
State ZIP Code
City
State ZIP Code
I authorize the disclosure of the requested information to the Social Security Administration.
NAME OF REQUESTOR

RELATIONSHIP TO PERSON ON RECORD SIGNATURE OF REQUESTOR

Page 1

Form SSA-L707 (06-2014) EF (06-2014)
Destroy Prior Editions

• The following information may assist you in locating the correct record:
Death Record
Full Name of Deceased (first, middle, last)
Date of Death (month, day, year)
Sex

State of Birth

Place of Death (city, county if known, state)
• If unable to locate record, please indicate years searched and sign
Marriage Record
Name of Groom or Party 1 (first, middle, last)
Date of Birth (month, day, year)
Place of Birth
Name of Bride or Party 2 (first, middle, last)
Date of Birth (month, day, year)
Place of Birth
Date of Marriage (month, day, year)
If date unknown, year(s) to be searched
County that issued license
County and state where marriage occurred
• If unable to locate record, please indicate years searched and sign.
Divorce Record
Name of Husband or Party 1 (first, middle, last)
Date of Birth (month, day, year)
Name of Wife or Party 2 (first, middle, last)
Date of Birth (month, day, year)
Date of Divorce (month, day, year)
If date unknown, year(s) to be searched
County and state where divorce occurred
• If unable to locate record, please indicate years searched and sign.

Page 2

Form SSA-L707 (06-2014) EF (06-2014)

Privacy Act Statement
Collection and Use of Personal Information
Section 205(a) of the Social Security Act, as amended, authorizes us to collect this information. We will use
the information you provide to determine eligibility of benefits for Social Security or Supplemental Security
Income applicants.
Furnishing us this information is voluntary. However, failing to provide us with all or part of the information
may prevent an accurate and timely decision on any claim filed.
We rarely use the information you supply us for any purpose other than to make a determination regarding
eligibility for benefits. However, we may use it for the administration and integrity of our programs. We may
also disclose the information to another person or to another agency in accordance with approved routine
uses, including but not limited to the following:
1. To enable a third party or agency to assist us in establishing rights to Social Security benefits and/or
coverage;
2. To comply with Federal laws requiring the release of information from our records (e.g., to the
Government Accountability Office and Department of Veterans Affairs);
3. To make determinations for eligibility in similar health and income maintenance programs at the
Federal, State, and local level; and,
4. To facilitate statistical research, audit, or investigative activities necessary to assure the integrity and
improvement of our programs (e.g., to the Bureau of the Census and to private entities under contract
with us).
We also may use the information you give us in computer matching programs. Matching programs
compare our records with records kept by other Federal, State and local government agencies. We use
the information from these programs to establish or verify a person's eligibility for federally funded or
administered benefit programs and for repayment of incorrect payments or delinquent debts under
these programs.
A complete list of routine uses of the information you provided us is available in our Systems of Records
Notices entitled, Claims Folder System, 60-0089 and Supplemental Security Income Record, and Special
Veterans Benefits, 60-0103. Additional information about these and other system of records notices and our
programs are available online at www.socialsecurity.gov or at your local Social Security office.

Paperwork Reduction Act Statement - This information collection meets the requirements of
44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to
answer these questions unless we display a valid Office of Management and Budget control number. We
estimate that it will take about 10 minutes to read the instructions, gather the facts, and answer the
questions. SEND OR BRING THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE.
You can find your local Social Security office through SSA's web site at www.socialsecurity.gov.
Offices are also listed under U.S. Governments agencies in your telephone directory or you may call
1-800-772-1213 (TTY 1-800-325-0778) for the address. You may send comments on our time estimates
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.
Page 3

Form SSA-L707 (06-2014) EF (06-2014)