OMB control number

Request for Social Security Statement

OMB 0960-0466 · SSA.

OMB 0960-0466

When an individual wants a Statement of earnings or quarters of coverage, as shown in SSA records, they can request it from SSA using Form SSA-7004. The SSA-7004 is available on our website for respondents to print, complete, and mail back to SSA. SSA uses the information from Form SSA-7004 to identify a respondent’s Social Security earnings records; extract posted earnings information; calculate potential benefit estimates; produce the resulting Social Security Statements; and mail them to the requestors. The respondents are Social Security number holders requesting information about their Social Security earnings records and estimates of their potential benefits.

The latest form for Request for Social Security Statement expires 2026-04-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form SSA-7004 Request for Social Security Statement--Paper Version Form
Addendum - 0466.docx Supplementary Document
Supporting Statement - 0466 (Final).docx Supporting Statement A
Request for Social Security Statement--Paper Version Form

All Historical Document Collections

202206-0960-001 Approved without change	Revision of a currently approved collection	2022-10-03
201905-0960-001 Approved without change	Revision of a currently approved collection	2019-08-19
201606-0960-003 Approved without change	Revision of a currently approved collection	2016-09-02
201302-0960-002 Approved without change	Revision of a currently approved collection	2013-07-30
201203-0960-002 Approved without change	No material or nonsubstantive change to a currently approved collection	2012-03-20
201002-0960-005 Approved without change	Revision of a currently approved collection	2010-07-12
200705-0960-016 Approved without change	Extension without change of a currently approved collection	2007-07-03
200405-0960-015 Approved without change	Extension without change of a currently approved collection	2004-05-27
200109-0960-013 Approved without change	No material or nonsubstantive change to a currently approved collection	2001-09-24
200103-0960-003 Approved without change	Extension without change of a currently approved collection	2001-03-26
199802-0960-006 Approved without change	Revision of a currently approved collection	1998-02-23
199704-0960-003 Approved with change	No material or nonsubstantive change to a currently approved collection	1997-04-24
199505-0960-006 Approved without change	Revision of a currently approved collection	1995-05-22
199112-0960-004 Approved without change	Extension without change of a currently approved collection	1991-12-09
198901-0960-006 Approved without change	Extension without change of a currently approved collection	1989-01-19
198811-0960-001 Approved without change	New collection (Request for a new OMB Control Number)	1988-11-21