Form Ssa-7050-F4 - Request For Social Security Earnings Information


Form Approved
OMB No. 0960-0525
*Use This Form If You Need
1. Certified/Non-Certified Detailed Earnings Information
Non-certified yearly totals of earnings
Includes periods of employment or self-employment and the
names and addresses of employers.
This service is free to the public.
These totals can be obtained by calling
1-800-772-1213 to receive Form SSA-7004,
2. Certified Yearly Totals of Earnings
Request for Earnings and Benefit Estimate
Includes total earnings for each year but does not include
the names and addresses of employers.
PRIVACY ACT NOTICE: We are authorized to collect this information under section 205 of the Social Security Act, and
the Federal Records Act of 1950 (64 Stat. 583). It is needed so we can identify your records and prepare the statement you
request. You do not have to furnish the information, but failure to do so may prevent your request from being processed.
PAPERWORK REDUCTION ACT: This information collection meets the clearance requirements of 44 U.S.C. §3507, as
amended by Section 2 of the Paperwork Reduction Act of 1995. You are not required to answer these questions unless we
display a valid Office of Management and Budget control number. We estimate that it will take you about 11 minutes to
read the instructions, gather the necessary facts, and answer the questions.
• How Do I Get This Information?
and it does not agree with your records), we
will supply you with more detail for the period
You need to complete the attached form to tell us
in question. Occasionally, earnings amounts
what information you want.
are wrong because an employer did not
correctly report earnings or earnings are
• Can I Get This Information For Someone Else?
credited to the wrong person. In situations like
these, we will send you detailed information, at
Yes, if you have their written permission. For
no charge, so we can correct your record.
more information, see page 3.
Be sure to show the year(s) involved on the
• Who Can Sign On Behalf Of The Individual?
request form and explain why you need the
information. If you do not tell us why you need
The parent of a minor child, or the legal guardian
the information, we will charge a fee.
of an individual who has been declared legally
incompetent, may sign if he/she is acting on behalf
We will certify the detailed earnings
of the individual.
information for an additional fee of $15.00.
Certification is usually not necessary unless you
• Is There A Fee For This Information?
plan to use the information in court.
1. Certified/Non-Certified Detailed
2. Certified Yearly Total of Earnings
Earnings Information
Yes, there is a fee of $15 to certify yearly totals
of earnings. Cetification is usually not
Yes, we usually charge a fee for detailed
necessary unless you plan to use the information
information. In most cases, this information is
in court.
used for purposes NOT directly related to Social
Security such as for a private pension plan or
personal injury suit. The fee chart on page 3
3. Method of Payment
gives the amount of the charge.
Enclose a check or money order for the entire
Sometimes, there is no charge for detailed
fee required. Payment can also be made by
information. If you have reason to believe your
credit card. To do so, complete page 4 of this
earnings are not correct (for example, you have
form and return it with your request form.
previously received earnings information from us
Form SSA-7050-F4 (1-2004)
EF (1-2004)
Destroy prior editions


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