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CMS-40B	Application for Enrollment in Medicare - Part B (Medical Insurance)
CMS-L564	Request for Employment Information
HA-501-U5	Request for Hearing by Administrative Law Judge
HA-520-U5	Request for Review of Hearing Decision/Order
HA-539	Notice Regarding Substitution of Party Upon Death of Claimant
HA-4608	Waiver of Your Right to Personal Appearance Before an Administrative Law Judge
HA-4631	Claimant's Recent Medical Treatment
HA-4632	Claimant's Medications
HA-4633	Claimant's Work Background
IRS SS-4	Application for Employer Identification Number
IRS W-4V	Voluntary Withholding Request
Online	Adult Disability Report
Online	Appeal a Recent Medical Decision
Online	Apply for Disability Benefits
Online	Apply for Retirement, Spouse's or Medicare Benefits
Online	Apply Online for Extra Help with Medicare Prescription Drug Plan Costs
Online	Change Address or Telephone Number
Online	Get a Replacement Medicare Card
Online	Representative Payee Accounting Report
Online	Request a Form SSA-1099/1042 (Benefit Statement) for tax or other purposes
Online	Request a Proof of Social Security Benefits Letter
Online	Request Special Notices for the Blind or Visually Impaired
Online	Sign Up For or Change Direct Deposit
SF-1199A	Direct Deposit Sign-Up Form
SSA-1-BK	Application for Retirement Insurance Benefits
SSA-2-BK	Application for Wife's or Husband's Insurance Benefits
SSA-5-BK	Application for Mother's or Father's Insurance Benefits
SSA-5-INST	Reporting Responsibilities for Mother's or Father's Insurance Benefits
SSA-7-F6	Application for Parent's Insurance Benefits
SSA-8	Application for Lump-Sum Death Payment
SSA-10	Application for Widow's or Widower's Insurance Benefits
SSA-10-INST	Reporting Responsibilities for Widow's or Widower's Insurance Benefits
SSA-16-BK	Application for Disability Insurance Benefits
SSA-16-BK-SP	Solicitud para beneficios de seguro por incapacidad
SSA-16-INST	Reporting Responsibilities For Disability Insurance Benefits
SSA-24	Application for Survivors Benefits (Payable Under Title II of the Social Security Act)
SSA-44	Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event
SSA-89	Authorization for the Social Security Administration To Release Social Security Number (SSN) Verification
SSA-89-SP	Autorización para que la Administración de Seguro Social Divulgue la Verificación de un Número de Seguro Social (SSN)
SSA-308	Modified Benefits Formula Questionnaire, Foreign Pension
SSA-437-BK	Complaint Form for Allegations of Discrimination in Programs or Activities Conducted by the Social Security Administration
SSA-437-BK-SP	Formulario Para Querellas De Alegaciones De Discriminación En Los Programas De La Administración Del Seguro Social
SSA-521	Request for Withdrawal of Application
SSA-546	Worker's Compensation/Public Disability Questionnaire
SSA-561-U2	Request for Reconsideration
SSA-623-F6	Representative Payee Report Not available online -contact your local Social Security office
SSA-671	Railroad Employment Questionnaire
SSA-781	Certificate of Responsibility for Welfare and Care of Child
SSA-789-U4	Request for Reconsideration - Disability Cessation
SSA-795	Statement of Claimant or Other Persons
SSA-820-BK	Work Activity Report (Self-Employed Person)
SSA-821-BK	Work Activity Report
SSA-827	Authorization to Disclose Information to the Social Security Administration
SSA-1020-INST	General Instructions for Completing the Application for Extra Help with Medicare Prescription Drug Plan Costs
SSA-1020B-INST	General Instructions for Completing the Application for Extra Help with Medicare Prescription Drug Plan Costs
SSA-1020B-INST-SP	Instrucciones generales para llenar la Solicitud para el Benefi cio Adicional con los gastos del plan de medicamentos recetados de Medicare
SSA-1021	Appeal of Determination for Extra Help with Medicare Prescription Drug Plan Costs
SSA-1021-SP	Apelación de la determinación para recibir el Beneficio Adicional con los gastos del plan de medicamentos recetados de Medicare
SSA-1021-INST	Instructions for Completing the Appeal of Determination for Extra Help with Medicare Prescription Drug Plan Costs
SSA-1021-INST-SP	Instrucciones para llenar la apelación de la determinación para recibir el beneficio adicional con los gastos del plan de medicamentos recetados de Medicare
SSA-1026B-OCR-SM-INST	Review of your Eligibility for Extra Help
SSA-1026B-OCR-SM-INST-SP	Revisión sobre su derecho a recibir el Beneficio Adicional
SSA-1560-U4	Petition to Obtain Approval of a Fee For Representing a Claimant Before the Social Security Administration
SSA-1694	Request for Business Entity Taxpayer Information
SSA-1695-F3	Identifying Information for Possible Direct Payment of Authorized Fees
SSA-1696-U4	Appointment of Representative
SSA-1724-F4	Claim for Amounts due in case of a Deceased Beneficiary
SSA-1945	Statement Concerning Your Employment in a Job Not Covered by Social Security
SSA-2000-F6	Application for Special Benefits for World War II Veterans
SSA-2032-BK	Request for Waiver of Special Veterans Benefits (SVB) Overpayment Recovery or Change in Repayment Rate
SSA-2512	Pre-1957 Military Service Federal Benefit Questionnaire
SSA-2519	Child Relationship Statement
SSA-3033	Employee Work Activity Questionnaire
SSA-3105	Important information about your appeal, waiver rights, and repayment options
SSA-3288	Consent for Release of Information
SSA-3288-SP	Consentimiento para divulgar información
SSA-3368-BK	Disability Report - Adult
SSA-3369-BK	Work History Report
SSA-3373-BK	Function Report - Adult
SSA-3380-BK	Function Report - Adult - Third Party Form
SSA-3381	Medical and Job Worksheet - Adult
SSA-3441-BK	Disability Report - Appeal
SSA-3885	Government Pension Questionnaire
SSA-4111	Certification of Election for Reduced Widow(er)'s and Surviving Divorced Spouse's Benefits
SSA-5665-BK	Teacher Questionnaire
SSA-5666	Request for Administrative Information
SSA-7008	Request for Correction of Earnings Record
SSA-7050-F4	Request for Social Security Earnings Information
SSA-7104	Partnership Questionnaire
SSA-7163	Questionnaire about Employment or Self Employment

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To see detail information on how to apply for Social Security Disability Benefits in the City of Stockton, Modesto, San Jose and Sacramento, please click on the links above.

Sacramento Area
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5230 Folsom Boulevard
Sacramento, CA 95819
Phone: (916) 455-4800
Fax: (916) 451-5687

Oakland Area
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1300 Clay Street, Ste 600
Oakland, CA 94612
Phone: (510) 663-4600
Fax: (510) 663-4660

Stockton & Modesto Area
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Sherwood Executive Center
5250 Claremont Avenue
Stockton, CA 95207
Phone: (209) 473-4800
Fax: (209) 478-5443

San Jose & Fremont Area
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3900 Newpark Mall Rd., 3rd Floor
Newark, CA 94560
Phone: (877) 876-4800
Fax: (510) 663-4660

877-876-4800 Tel
877-751-5897 Fax