Form preview

SSA-1372-BK 2004 free printable template

Get Form
Form Approved OMB No. 0960-0105 SOCIAL SECURITY ADMINISTRATION ADVANCE NOTICE OF TERMINATION OF CHILD'S BENEFITS NAME AND ADDRESS SOCIAL SECURITY CLAIM NUMBER — NAME OF CHILD BENEFICIARY TO WHOM
pdfFiller is not affiliated with any government organization

Get, Create, Make and Sign

Edit
Edit your ssa1372 2004 form form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your ssa1372 2004 form form via URL. You can also download, print, or export forms to your preferred cloud storage service.

Editing ssa1372 online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
Use the instructions below to start using our professional PDF editor:
1
Check your account. If you don't have a profile yet, click Start Free Trial and sign up for one.
2
Prepare a file. Use the Add New button to start a new project. Then, using your device, upload your file to the system by importing it from internal mail, the cloud, or adding its URL.
3
Edit ssa1372. Rearrange and rotate pages, add and edit text, and use additional tools. To save changes and return to your Dashboard, click Done. The Documents tab allows you to merge, divide, lock, or unlock files.
4
Save your file. Select it in the list of your records. Then, move the cursor to the right toolbar and choose one of the available exporting methods: save it in multiple formats, download it as a PDF, send it by email, or store it in the cloud.
With pdfFiller, it's always easy to work with documents.

SSA-1372-BK Form Versions

Version
Form Popularity
Fillable & printabley
4.8 Satisfied (117 Votes)
4.4 Satisfied (138 Votes)
4.4 Satisfied (581 Votes)
4.0 Satisfied (43 Votes)

How to fill out ssa1372 2004 form

Illustration

How to fill out SSA1372:

01
Start by gathering all the necessary information and documents such as the applicant's Social Security number, date of birth, and any relevant medical records or treatment history.
02
Begin filling out the form by providing the applicant's personal information, including their full name, address, and contact details.
03
In the next section, indicate the type of benefit the applicant is applying for, whether it's disability, retirement, or survivor benefits.
04
Provide information about the applicant's work history, including their past employers, dates of employment, and job titles.
05
Indicate any other benefits the applicant may be receiving, such as workers' compensation or veterans' benefits.
06
The next section of the form requires details about the applicant's medical conditions or impairments. Provide a comprehensive list of all diagnosed medical conditions, including the dates of diagnosis and names of treating physicians.
07
If the applicant is currently receiving medical treatment, provide information about the healthcare providers and treatment facilities involved.
08
If there are additional remarks or comments that need to be included, there is a designated section towards the end of the form to do so.
09
Review the completed form for accuracy and make sure all required fields are filled out correctly.
10
Finally, sign and date the form, certifying that the information provided is true and accurate to the best of your knowledge.

Who needs SSA1372:

01
Individuals who are applying for Social Security benefits, such as disability, retirement, or survivor benefits, may need to fill out SSA1372.
02
The form is required by the Social Security Administration (SSA) to gather pertinent information about the applicant's personal, medical, and work history in order to determine eligibility for benefits.
03
Medical information included in SSA1372 helps establish the severity of the applicant's conditions and their impact on their ability to work or function independently.
04
SSA1372 is typically required for both initial benefit applications and when requesting a review or appeal of a previously denied claim.
05
The form is essential for the SSA to assess an individual's eligibility for various Social Security benefits and determine the appropriate level of financial assistance they may be entitled to.

Fill form : Try Risk Free

Rate free

4.0
Satisfied
43 Votes

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

SSA-1372 is a form used by the Social Security Administration to report wages for household employees.
Employers who pay wages to household employees and withhold Social Security and Medicare taxes are required to file SSA-1372.
SSA-1372 can be filled out online on the Social Security Administration's website or by submitting a paper form.
The purpose of SSA-1372 is to report wages for household employees and ensure that the proper taxes are withheld.
SSA-1372 requires the employer to report the employee's name, Social Security number, wages paid, and taxes withheld.
The deadline to file SSA-1372 in 2023 is January 31st.
The penalty for late filing of SSA-1372 is $50 per form, with a maximum penalty of $536,000 per year.
ssa1372 and other documents can be changed, filled out, and signed right in your Gmail inbox. You can use pdfFiller's add-on to do this, as well as other things. When you go to Google Workspace, you can find pdfFiller for Gmail. You should use the time you spend dealing with your documents and eSignatures for more important things, like going to the gym or going to the dentist.
Once your ssa1372 is ready, you can securely share it with recipients and collect eSignatures in a few clicks with pdfFiller. You can send a PDF by email, text message, fax, USPS mail, or notarize it online - right from your account. Create an account now and try it yourself.
Create, modify, and share ssa1372 using the pdfFiller iOS app. Easy to install from the Apple Store. You may sign up for a free trial and then purchase a membership.

Fill out your ssa1372 2004 form online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview

Related Forms