Authorization to Disclose Information to Social Security

Fill out the official form

Use these notes alongside the official instructions. Complete your answers on the agency's form.

Document format: PDF filling support unknown. Checked 2026-10-05. Signature support and agency acceptance still need confirmation.

1. Enter the identity of the person whose records are being disclosed.

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   NAME ( First, Middle, Last, Suffix ) SSN Birthday (MM/DD/YYYY)

   Official source · Checked 2026-10-05

2. Read both pages before signing.

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   PLEASE READ THE ENTIRE FORM, BOTH PAGES, BEFORE SIGNING BELOW

   Official source · Checked 2026-10-05

3. Leave the SSA/DDS identification box for the agency unless instructed otherwise.

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   THIS BOX TO BE COMPLETED BY SSA/DDS

   Official source · Checked 2026-10-05

4. Use the managing-benefits-only checkbox only when it applies.

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   Determining whether I am capable of managing benefits ONLY (check only if this applies)

   Official source · Checked 2026-10-05

5. For a paper signature, use blue or black ink.

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   PLEASE SIGN USING BLUE OR BLACK INK ONLY

   Official source · Checked 2026-10-05

6. If someone other than the record subject signs, state the authority to sign.

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   IF not signed by subject of disclosure, specify basis for authority to sign

   Official source · Checked 2026-10-05

7. Use the additional representative signature field only when required by applicable state law.

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   Parent/guardian/personal representative sign here if two signatures required by State law

   Official source · Checked 2026-10-05

8. Enter the signing date.

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   Date Signed

   Official source · Checked 2026-10-05

9. Enter a contact phone number including area code.

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   Phone Number (with area code)

   Official source · Checked 2026-10-05

10. Complete the address fields.

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    Street Address City State ZIP

    Official source · Checked 2026-10-05

11. A witness is needed only if you sign with a mark (X) or a specific records source requires one; SSA does not delay a claim to get a witness otherwise. If a witness is needed, they complete the identity attestation, signature and contact fields.

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    Do not delay the claim to seek the claimant's witnessed signature unless the claimant signed Form SSA-827 by mark or the FO knows from experience that certain sources require a witnessed signature.

    Official source · Checked 2026-10-05

12. Use the second-witness field when needed, including the form’s stated X-signature example.

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    IF needed, second witness sign here (e.g., if signed with "X" above)

    Official source · Checked 2026-10-05

Where to submit

Send or bring the completed form to the local Social Security office; the Baltimore address is for burden-estimate comments only.

Source and date checked

SEND OR BRING THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE.

Official source · Checked 2026-10-05

Fees

Unknown — confirm the current instructions with the agency.

Fee waivers

Unknown — confirm the current instructions with the agency.

Restrictions

Unknown — confirm the current instructions with the agency.