The application form (SS-5) contains the following information:
Full name at birth (including maiden name)
Present mailing address
Age at last birthday
Date of birth
Place of birth (City, county, state)
Father's full name "regardless of whether living or dead"
Mother's full name, including maiden name, "regardless of whether living or dead"
Sex and race
Ever applied for SS number/Railroad Retirement before? Yes/No
Current employer's name and address
Social Security Administration
Office of Earnings Operations
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, or a corresponding NUMIDENT printout (see below) for the following individual:
Birth: 21 Sep 1938
Death: Jul 1979
This individual is deceased, having been listed in the Social Security Administration's Death Master File. I understand the fee for this service is $27 for copy of original SS-5 application printout when the Social Security Number is provided. I am requesting a SS-5 copy Included is a check for $27 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.
Daytime Phone Number: