Form SSA-85 Information Needed to Review Your Social Security Claim

Form SSA-85 (09-2022)
Discontinue Prior Editions
Social Security Administration

Page 1 of 3
OMB No. 0960-0189

INFORMATION NEEDED TO REVIEW YOUR SOCIAL SECURITY CLAIM
Claim Number: XXX-XXPlease have documents or proof of the ITEMS CHECKED below available for your interview if you have them in your possession.
This will help us complete the review of your claim more quickly. Please mention in your interview any information that relates to
you, even if not checked below. With the exception of W-2 forms and tax returns, we must see the original document or a
copy certified by the custodian of the record or by a representative in your local Social Security office.
Social Security or Medicare card for
Birth or baptismal certificate recorded before you were age 5 - otherwise, at least two of the following documents are
needed: school records, census records, delayed birth certificate, children's birth certificates, family Bible, naturalization
certificate, etc.
Records of age will also be needed for
Marriage certificates for you and
Divorce or annulment decrees for all prior marriages
Death certificates for
Social Security numbers for all former spouses
Proof of military service
Pay slips or W-2 forms for
Self-employment tax returns for
A copy of the earnings record for the account on which you are receiving benefits is enclosed. Please review the earnings
and compare them with your records. I have highlighted some specific years that I would like to discuss with you.
If you disagree with any of these earnings, please have your records available at the time of the interview. W-2 forms are
the best evidence of wages. Tax returns and proof of filing are the best evidence of self-employment income.
Other

Form SSA-85 (09-2022)

Page 2 of 3
Claim Number: XXX-XX-

The Earnings Record
Your benefits are based on giving credit for any earnings that were covered under the Social Security Act since 1937. As part of
our review, we check your earnings record for accuracy.
The earnings record shows yearly amounts for 1951 to recent years. For years not shown, there were no earnings reported to
Social Security. There is a separate total for earnings during 1937 through 1950.
Please compare the earnings amounts to any records you have. Please pay particular attention to:
• Years with no earnings
• Years with earnings much higher than the ones before and after them
• Years with earnings much lower than the ones before and after them
If you disagree with any of these earnings, please have your records available at the time of the interview. W-2 forms
are the best evidence of wages. Tax returns and proof of filing are the best evidence of self-employment earnings.

Form SSA-85 (09-2022)

Page 3 of 3
Claim Number: XXX-XX-

Privacy Act Statement
Collection and Use of Personal Information
Sections 205(a), 228(a), 1614(a) and 1836 of the Social Security Act, as amended, allow us to collect this information.
Furnishing us this information is voluntary. However, failing to provide all or part of the information may prevent us from making
an accurate and timely decision on your claim.

See Revised PA Statement attached

We will use the information to review your claim. We may also share your information for the following purposes, called routine
uses:
1. To third party contacts in situations where the party to be contacted has, or is expected to have, information relating to the
individual's capability to manage their affairs or eligibility for or entitlement to benefits under the Social Security program
when the data are needed to establish the validity of evidence or to verify the accuracy of information presented by the
individual; and
2. To applicants, claimants, prospective applicants or claimants, other than the data subject, their authorized representatives
or representative payees to the extent necessary to pursue Social Security claims and to representative payees when the
information pertains to individuals for whom they serve as representative payees, for the purpose of assisting SSA in
administering its representative payment responsibilities under the Act and assisting the representative payees in performing
their duties as payees, including receiving and accounting for benefits for individuals for whom they serve as payees.
In addition, we may share this information in accordance with the Privacy Act and other Federal laws. For example, where
authorized, we may use and disclose this information in computer matching programs, in which our records are compared with
other records to establish or verify a person's eligibility for Federal benefit programs and for repayment of incorrect or delinquent
debts under these programs.
A list of additional routine uses is available in our Privacy Act System of Records Notice (SORN) 60-0089, entitled Claims
Folders Systems. Additional information and a full listing of all our SORNs are available on our website at
www.socialsecurity.gov/foia/bluebook.

Paperwork Reduction Act Statement
See Revised PRA Statement attached

This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the
Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management
and Budget (OMB) control number. We estimate that it will take about 5 minutes to read the instructions, gather the facts, and
answer the questions. Send only comments regarding this burden estimate or any other aspect of this collection,
including suggestions for reducing this burden to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401.