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Request for Social Security Statement

Form SSA-7004 (06-2022) Discontinue Prior Editions Social Security AdministrationPage 1 of 3 OMB No. 0960-0466 Request for Social Security StatementWithin four to six weeks after you return this form, we will send you: a record of your earning history; an estimate of how much you have paid in Social Security taxes; and estimates of benefits you (and your family) may be eligible for now and in the note: If you have received periodic Social Security Statements in the mail, this Request may stop your next scheduled hope you will find the Statement useful in planning your financial future.

If you have questions about Social Security or this form, please call our toll-free number, 1-800-772-1213 (TTY 1-800-325-0778) Please check this box if you want to get your . Statement. in Spanish instead of English. Please print or type your answers. When you have completed the form, mail it to: Social Security Administration

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