Form SSA-827 Authorization to Disclose Information to the Social Security Administration (Ssa)

Form SSA-827 Instructions

You have a right to withdraw your authorization at any time. To do so, send or bring your written statement to the nearest Social Security office. Send one more copy directly to the source you want to stop disclosing your personal information. The SSA has the right to use the information received before revocation to make a decision on your benefit claim. If not revoked, the authorization provided by the form is valid for 12 months from the date signed.

The SSA policy includes providing services to people with limited English proficiency in the language they prefer. Inform your local SSA office about the case, and the SSA officials will make every reasonable effort to provide you with the information about SSA Form 827 in the language you prefer.

Official SSA-released instructions for completing the form are provided on Form SSA-827-INST, Instructions for Completing the SSA-827.

How to Fill Out Form SSA-827?

1. Provide the first, middle, last name, suffix, date of birth, and Social Security Number (SSN) of the individual whose records are to be disclosed.
2. Read both pages of the form carefully before signing it. Sign the form using only blue or black ink.
3. If the SSA only determines whether you can manage your benefits, check the applicable box in the section "Purpose."
4. If you are not the subject of disclosure, specify your authority by checking the appropriate box; if you are a personal representative rather than a parent or guardian of minor, explain your relationship to the claimant in the space provided under the checkbox; note, that representative payees and appointed representatives are not allowed to sign the SSA authorization to disclosure information form.
5. Provide your contact information in the applicable boxes (include your phone number with area code, street address, city, state, and ZIP code).
6. The "Witness" section is optional. The federal laws do not require the verification of your identity with witnesses' signatures. However, the witness' signature may be required by state law. Moreover, the form must contain the witness's signature if you sign your authorization with "X." In this case, the person who knows the individual signing the form or is satisfied with the individual's identity has to sign in the appropriate box and provide either a mailing address or phone number.

Not what you were looking for? Check out these related forms:

• Form SSA-89, Authorization for the Social Security Administration to Release Social Security Number (SSN) Verification, or Form SSA-89-SP (Spanish) allow the SSA to verify if your name and the SSN matches their records, and to confirm this information to the third party named in the form. It is usually used to prevent identity fraud;
• Form SSA-3288, Consent for Release of Information, or Form SSA-3288-SP (Spanish) are completed when you want the SSA to provide the third party with the information from your record. You can also request the release of records on behalf of a minor or incompetent person.