Fillable AUTHORIZATION FOR THE SOCIAL SECURITY ... - LegisIT
SOCIAL SECURITY ADMINISTRATION
Form Approved OMB No. 0960-0293
AUTHORIZATION FOR THE SOCIAL SECURITY ADMINISTRATION TO OBTAIN ACCOUNT RECORDS FROM A FINANCIAL INSTITUTION AND REQUEST FOR RECORDS
CUSTOMER'S NAME SOCIAL SECURITY NUMBER
NAME AND ADDRESS OF FINANCIAL INSTITUTION
APPLICANT/RECIPIENT IF OTHER THAN CUSTOMER
SOCIAL SECURITY NUMBER
ACCOUNT NUMBER(S) (INDIVIDUAL OR JOINT)
A request for records...
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