Social Security Administration
Office of Earnings Operations
FOIA Workgroup
300 N. Greene Street
P.O. Box 33022
Baltimore, Maryland 21290

Re: Freedom of Information Act Request

Dear Freedom of Information Officer,

I am writing this request under the Freedom of Information Act, 5 U.S.C. Section 552. I hereby request a copy of the SS-5,
Application for Social Security Card, for the following individual:

NAME of DECEASED
SS#
Birth:
Death:

This individual is deceased, having been listed in the Social Security Administration's Death Master File. I understand the fee
for this service is $7.00 when the Social Security Number is provided. Included is a check for $______ made out to the
Social Security Administration to cover any administrative costs required by this request.

Please respond to my request upon receipt of this initial correspondence. Thank you for your attention and assistance.

Sincerely,
 
 
 

Address:

Daytime Phone Number: