This version of the form is not currently in use and is provided for reference only. Download this version of Form SSA-827 for the current year.
Form SSA-827, Authorization to Disclose Information to the Social Security Administration , is a form used for providing written consent to release your personal information from medical, educational, and other required sources to the U.S. Social Security Administration (SSA). The latest version of the form was released on November 1, 2012 . Later editions are valid and can be used until exhausted. An SSA-827 fillable form is available for download and digital filing through the link below.
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According to U.S. law, a medical, educational, or any other institution can release your personal information to the SSA only after it receives your signed authorization. The most convenient way to provide the authorization is to fill out the SSA-827. It is specifically designed to ensure you have all the information required for informed authorization and are advised on the particularities of a disclosure.
Federal laws allow the institutions that maintain your personal information to release this information if you sign only one authorization that allows releasing all your personal information from all possible sources. The SSA officials will copy your authorization for each source they need to obtain information from.
Form SSA-827 FAQ
Q: Which states need a second witness signature on Form SSA-827?
A: Form SSA-827 includes space for a second witness's signature and contacts. The following states require that any documents being recorded within these states must be testified with two witnesses:
Q: Where to mail Form SSA-827?
A: Mail or take the completed form to the local Social Security office. Specify the address of your local office on the SSA website, in your telephone directory under the U.S. Government agencies, or by calling a toll-free number provided on the second page of the form. The SSA accepts pen and ink signed forms by fax too.
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.
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