PDF document

- 1 -

Form SSA-7050-F4 (11-2022)
Discontinue Prior Editions Page 1 of 4
Social Security Administration OMB No. 0960-0525
REQUEST FOR SOCIAL SECURITY EARNING INFORMATION
*Use This Form If You Need
DO NOT USE THIS FORM TO REQUEST
1. Certified/Non-Certified Detailed Earnings Information YEARLY EARNINGS TOTALS
Includes periods of employment or self-employment
and the names and addresses of employers. Yearly earnings totals are free to the public
if you do not require certification.
2. Certified Yearly Totals of Earnings
Includes total earnings for each year but does not To obtain FREE yearly totals of earnings,
include the names and addresses of employers. visit our website at www.ssa.gov/myaccount.

Privacy Act Statement
Collection and Use of Personal Information

Section 205 of the Social Security Act, as amended, allows us to collect this information. In addition, the Budget and
Accounting Act of 1950 and Debt Collection Act of 1982 authorize us to collect credit card information, if you choose to
pay for the earnings information you have requested with a credit card. Furnishing us this information is voluntary.
However, failing to provide all or part of the information may prevent us from processing your request.

We will use the information to identify your records, process your request, and send the earnings information you request.
We may also share the information for the following purposes, called routine uses:

1. To the Internal Revenue Service (IRS) for auditing SSA's compliance with the safeguard provisions of the Internal
Revenue Code of 1986, as amended.

2. To contractors and other Federal agencies, as necessary, for the purpose of, assisting the Social Security
Administration (SSA) in the efficient administration of its programs.

3. To banks enrolled in the Treasury credit card network to collect a payment or debt when the individual has given
his/her credit card number for this purpose.

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 Notices (SORNs) 60-0059, entitled
Earnings Recording and Self-Employment Income System, 60-0090, entitled Master Beneficiary Record, 60-0224,
entitled SSA-Initiated Personal Earnings and Benefit Estimate Statement, and 60-0231, entitled Financial Transactions of
SSA Accounting and Finance Offices. 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 -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 control number. We estimate that it will take about 11 minutes to read
the instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate above
to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401.

- 2 -

Form SSA-7050-F4 (11-2022)                                                                         Page 2 of 4

               REQUEST FOR SOCIAL SECURITY EARNING INFORMATION 
1.  Provide your name as it appears on your most recent Social Security card or the name of the individual whose 
     earnings you are requesting.  

First Name:                                                                                      Middle Initial:

Last Name:

Social Security Number (SSN)                                   One SSN per request

Date of Birth:                                                Date of Death:

Other Name(s) Used 
Maiden Name
2. What kind of earnings information do you need? (Choose ONE of the following types of earnings or SSA must return 
this request.)
Itemized Statement of Earnings $100.00
                                                               Year(s) Requested:                to
(Includes the names and addresses of employers)
If you check this box, tell us why you need this               Year(s) Requested:                to
information below.
                                                                            Check this box if you want the earnings 
                                                                            information CERTIFIED for an additional 
                                                                            $44.00 fee.

Certified Yearly Totals of Earnings $44.00
                                                               Year(s) Requested:                to
(Does not include the names and addresses of 
employers)Yearly earnings totals are FREE to the public if you                                   to
                                                               Year(s) Requested:
do not require certification. To obtain FREE yearly totals of 
earnings, visit our website at www.ssa.gov/myaccount.
3. If you would like this information sent to someone else, please fill in the information below.
I authorize the Social Security Administration to release the earnings information to:

Name

Address                                                                                          State

City                                                                                    ZIP Code
4. I am the individual to whom the record pertains (or a person authorized to sign on behalf of that individual).  
    I declare under penalty of perjury that I have examined all the information on this form, and on any accompanying 
statements or forms, and it is true and correct to the best of my knowledge.
                                                                            SSA must receive this form within 120 days  
     Signature AND Printed Name of Individual or Legal Guardian             from the date signed
                                                                            Date

Relationship (if applicable, you must attach proof)                         Daytime Phone:

Address                                                                                          State

City                                                                                    ZIP Code
Witnesses must sign this form ONLY if the above signature is by marked (X). If signed by mark (X), two witnesses to the 
signing who know the signee must sign below and provide their full addresses. Please print the signee's name next to the 
mark (X) on the signature line above. 
1. Signature of Witness                                        2. Signature of Witness

Address (Number and Street, City, State and ZIP Code)          Address (Number and Street, City, State and ZIP Code)

- 3 -

Form SSA-7050-F4 (11-2022) Page 3 of 4

REQUEST FOR SOCIAL SECURITY EARNING INFORMATION
INFORMATION ABOUT YOUR REQUEST
You may use this form to request earnings information for one ONE Social Security Number (SSN)
How do I get my earnings statement? Is There A Fee For Earnings Information?

You must complete the attached form. Tell us the Yes. We charge a $100.00 fee for providing information
specific years of earnings you want, type of earnings for purposes unrelated to the administration of our
record, and provide your mailing address. The itemized programs.
statement of earnings will be mailed to ONE address,
therefore, if you want the statement sent to someone 1. Certified or Non-Certified Itemized Statement of
other than yourself, provide their address in section 3. Earnings
Mail the completed form to SSA within 120 days of In most instances, individuals request Itemized
signature. If you sign with an "X", your mark must be Statements of Earnings for purposes unrelated to
witnessed by two impartial persons who must provide our programs such as a private pension plan or
their name and address in the spaces provided. personal injury suit. Bulk submitters may email
Select ONE type of earnings statement and include the OCO.Pension.Fund@ssa.gov for an alternate
appropriate fee. method of obtaining itemized earnings information.

1. Certified/Non-Certified Itemized Statement of We will certify the itemized earnings information for
Earnings an additional $44.00 fee. Certification is usually not
This statement includes years of self-employment or necessary unless you are specifically requested to
employment and the names and addresses of obtain a certified earnings record.
employers.
Sometimes, there is no charge for itemized earnings
2. Certified Yearly Totals of Earnings information. If you have reason to believe your
This statement includes the total earnings for each earnings are not correct (for example, you have
year requested but does not include the names and previously received earnings information from us
addresses of employers. and it does not agree with your records), we will
supply you with more detail for the year(s) in
If you require one of each type of earnings statement, question. Be sure to show the year(s) involved on
you must complete two separate forms. Mail each form the request form and explain why you need the
to SSA with one form of payment attached to each information. If you do not tell us why you need the
request. information, we will charge a fee.

How do I get someone else's earnings
statement? 2. Certified Yearly Totals of Earnings
We charge $44.00 to certify yearly totals of
You may get someone else's earnings information if you earnings. However, if you do not want or need
meet one of the following criteria, attach the necessary certification, you may obtain yearly totals FREE of
documents to show your entitlement to the earnings charge at www.ssa.gov/myaccount. Certification is
information and include the appropriate fee. usually not necessary unless you are advised
specifically to obtain a certified earnings record.
1. Someone Else's Earnings
The natural or adoptive parent or legal guardian of a Method of Payment
minor child, or the legal guardian of a legally This Fee Is Not Refundable. DO NOT SEND CASH.
declared incompetent individual, may obtain
earnings information if acting in the best interest of You may pay by credit card, check or money order.
the minor child or incompetent individual. You must • Credit Card Instructions
include proof of your relationship to the individual Complete the credit card section on page 4 and
with your request. The proof may include a birth return it with your request form.
certificate, court order, adoption decree, or other
legally binding document. • Check or Money Order Instructions
Enclose one check or money order per request
2. A Deceased Person's Earnings form payable to the Social Security
You can request earnings information from the Administration and write the Social Security
record of a deceased person if you are: number in the memo.
• The legal representative of the estate;
• A survivor (that is, the spouse, parent, child, How long will it take SSA to process my request?
divorced spouse of divorced parent); or
• An individual with a material interest (e.g., Please allow SSA 120 days to process this request.
financial) who is an heir at law, next of kin, After 120 days, you may contact 1-800-772-1213 to
beneficiary under the will or donee of property of leave an inquiry regarding your request.
the decedent.

You must include proof of death and proof of your
relationship to the deceased with your request.

- 4 -

Form SSA-7050-F4 (11-2022) Page 4 of 4

REQUEST FOR SOCIAL SECURITY EARNING INFORMATION
· Where do I send my complete request?
Mail the completed form, supporting documentation, If using private contractor such as FedEx mail form,
and applicable fee to: supporting documentation, and application fee to:
Social Security Administration Social Security Administration
P.O. Box 33011 P.O. Box 33011
Baltimore, Maryland 21290-33011 Baltimore, Maryland 21290-33011

· How much do I have to pay for an Itemized Statement of Earnings?

Non-Certified Itemized Statement of Earnings Certified Itemized Statement of Earnings
$100.00 $144.00
· How much do I have to pay for Certified Yearly Totals of Earnings?
Certified yearly totals of earnings cost $44.00. You may obtain non-certified yearly totals FREE of charge at
www.ssa.gov/myaccount. Certification is usually not necessary unless you are specifically asked to obtain a
certified earnings record.
YOU CAN MAKE YOUR PAYMENT BY CREDIT CARD
As a convenience, we offer you the option to make your payment by credit card. However, regular credit card rules will
apply. You also pay by check or money order. Make check payable to Social Security Administration.
Visa American Express
CHECK ONE
MasterCard Discover

Credit Card Holder's Name
(Enter the name from the credit card) First Name, Middle Initial, Last Name

Credit Card Holder's Address Number & Street

City, State, & ZIP Code

Daytime Telephone Number
Area Code
Credit Card Number

Credit Card Expiration Date
(MM/YY)
Amount Charged
See above to select the correct fee for your request.
Applicable fees are $44.00, $100.00, or $144.00. $
SSA will return forms without the appropriate fee.

Credit Card Holder's Signature
Date

Authorization

DO NOT WRITE IN THIS SPACE Name Date
OFFICE USE ONLY
Remittance Control #

PDF file checksum: 2574326211

(Plugin #1/9.12/13.0)