Form SSA-3288 [Social Security Administration] – How to Fill Guide

How to fill Social Security Administration Form SSA-3288

Form SSA-3288 stands for the ‘Social Security Administration Consent for Release of Information.’ This is basically a document that provides the official and written consent for groups and players who might be in need of specific pieces of information which might assist in securing the necessary financial assistance for a needy person.

By definition,

Social Security Administration Form, also referred to as Form SSA-3288, issued by the SSA is a document used to provide official written consent to a third party i.e., a doctor, insurance company, or any other party looking to disclose personal information maintained by the SSA such as social security number, current social security or supplemental security income benefit amount, medical records or Medicare eligibility, etc.

The latest version of the SSA-3288 Form was issued by SAA on November 1st, 2016.

Why is the SSA-3288 Form Used?

Various instances warrant the use of the SSA-3288 form. Some of the most common scenarios include:

  • When one is looking to have the SSA verify their Social Security Number
  • When one is looking to have their social security benefits sent to an insurance company or other organizations
  • If one is looking to have the SSA release or share any information with a third party regarding their Medicare eligibility benefits or medical records

NOTE: If you are looking to release information regarding your earnings or employment history, you should consider filling out Form SSA-7050-F4.

It is also vital to understand that different states have different laws regarding the authorization of release of personal information when it comes to minors. The SSA form can be used to release information about a minor or a legally incompetent adult. The form can also be used by a parent or legal guardian or a minor to request the release of non-medical information. The SSA form cannot be used to release a minor’s medical records. For this one will have to visit their local SSA office or contact them directly.

How to Fill Form SSA-3288

There are several fields that you will be required to fill in the SSA-3288 form. Make sure that all the information required is well captured in the form. Below is a step-by-step comprehensive guide on how to fill out the form SSA-3288:

Step I: Download the form

Needless to point out, you have to first and foremost download the SSA-3288 form from the official government portal. Follow this link to access the form online or download it from here:

https://www.ssa.gov/forms/ssa-3288.pdf

Social Security Administration Consent for Release of Information (Form SSA-3288)

Beware of potential scammers. There are various sites that masquerade as legitimate government sites. They will usually extort money from you and steal your identity from the information you give.

Upon downloading the SSA-3288 form, you are required to review all the terms that are stipulated on the form. In case there are any issues that might be ambiguous, you are required to seek further clarification.

Should you find the document too complicated, you are advised to seek external assistance typically from the nearest social security office or agent.

Step II: Fill the basic details

You now have to fill out your basic details. You will find these on the second page of the SSA-3288 form. The details mainly encompass the following areas:

  • Your full name
  • Date of birth in the mm//dd/yyyy format
  • Social security number

Step III: Sanction the release of your records and documents

Flip over to the next page. Here, you will sanction the release of your records and documents. To do this, you have to furnish the organizations and persons who are to be allowed to access those records. Then, you will state the reasons which this information has to be released. These you do in the lines provided for.

Step IV: Specify the information

Turn over to the next page. You will now specify the precise piece of information you would wish released. Choose from the list below:

  • Social Security Number
  • Present social security benefit amounts
  • Present supplemental security income monthly payment amount
  • Benefit amounts
  • Medicare entitlement
  • Medical Records from claims folder(s)
  • Complete medical records from claim folder(s)
  • Other records from files (clarify in the lines provided)

Step V: Append your signature

Conclude the exercise by appending your signature. You are advised to read the agreement fully and then accept the terms of references. This is to let you make informed decisions thereafter. Lastly, furnish the following pieces of information:

  • Your signature as a caregiver or self
  • Date of signature
  • Complete address
  • Your relation with the applicant
  • Daytime telephone number
  • Signature of the witnesses
  • The physical address of the witnesses (inclusive of the zip code)

NB: The witness only signs if the applicant’s signature is missing, bears an ‘X’ sign, or any other dedicated mark.

Where to Send SSA-3288 Form ?

After filling out the Social Security Administration SSA-3288 form, send or bring it to your nearest Social Security office. Go through the SSA’s official website to find out the address of your local office. You can also find the address by calling the toll-free number provided on the first page of the SSA form or by checking the telephone directory under the US government agencies.

Conclusion

The release of personal information is a grave issue that must be handled with utmost care. Releasing information to unauthorized parties may lead to mismanagement of such information, resulting in identity theft, tainted identity, and stigmatization in the case of medical records. Therefore, it is important to fill out form SSA-3288 to make sure that only authorized parties are granted permission to disclose certain personal information to third parties.

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