Complete this form only if you want us to give information or records about you, a minor, or a legally incompetent adult, to an individual or group (for example, a doctor or an insurance company).

Complete this form only if you want us to give information or records about you, a minor, or a legally incompetent adult, to an individual or group (for example, a doctor or an insurance company).

If you download, print and complete a paper form, please mail or take it to your local Social Security office or the office that requested it from you. Important Note: PDFs you open from this page may default to opening within a browser, depending on your browser settings.

If you are the natural or adoptive parent or legal guardian, acting on behalf of a minor child, you may complete this form to release only the minor's non-medical records. We may charge a fee for providing information unrelated to the administration of a program under the Social Security Act. NOTE: Do not use this form to:

If you are seeking Social Security Administration claim file records about another living individual, you must have the individual complete the Form SSA-3288 or any other paper consent that meets our consent requirements to request the individual’s records.

2. Fillable version of Form SSA-3288 (07-2013) The fillable SSA-3288 (07-2013) requires the consenting individual to provide a wet signature. If an individual’s signature is by mark “X”, two witnesses to the signing of the individual’s mark “X” must also provide wet signatures.

TN 5 (11-15) GN 03305.999 Exhibit – Form SSA-3288 Exhibit – Form SSA-3288 (Social Security Administration Consent for Release of Information) Model Consent Form SSA-3288 (Social Security Administration Consent for Release of Information).

You can sign and submit a written statement appointing the person, or use our standard form SSA-1696, Appointment of Representative. You can use our electronic version of the form by asking your representative to start an online submission where you both can complete your appointment electronically without personal contact.

SEND OR BRING THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. You can find your local Social Security office through SSA’s website at www.socialsecurity.gov. Offices are also listed under U. S. Government agencies in your telephone directory or you may call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).

SEND OR BRING THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. You can find your local Social Security office through SSA’s website at www.socialsecurity.gov. Offices are also listed under U. S. Government agencies in your telephone directory or you may call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).