Print your full name and your own Social Security Number as they appear on your Social Security card. Your Social Security Number may be different from the number on your Medicare card.

You can electronically complete, upload, and submit select forms to Social Security using the Upload Documents feature. You can also fax or mail any paper form to your local office, unless otherwise …

Fill out the Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event (SSA-44) (PDF) form. Fax or mail your completed form and evidence to a Social Security office.

Request a disability reconsideration: If you applied for Social Security or Supplemental Security Income (SSI) disability benefits and were denied for medical reasons, you may request an appeal online.

You can use our electronic version of the form by asking your representative to start an online submission where you both can complete your appointment electronically without personal contact.

If you have any questions about this form or about the evidence documents you must provide, please visit our website at www.socialsecurity.gov for additional information as well as locations of our …

SEND OR BRING THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. You can find your local Social Security office through SSA’s website at www.socialsecurity.gov. Offices are …

I authorize the Social Security Administration to verify my name and SSN to the Company and/or the Company's Agent, if applicable, for the purpose I identified.

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.

If you applied for Social Security or Supplemental Security Income (SSI) disability benefits and were denied for medical reasons, you may request an appeal online.