
0960-0623 WHOSE Records to be Disclosed NAME (First, Middle, Last, Suffix) SSN - Birthday - (mm/dd/yy) AUTHORIZATION TO DISCLOSE INFORMATION TO THE SOCIAL SECURITY ADMINISTRATION (SSA) ** PLEASE READ THE ENTIRE FORM, BOTH PAGES, BEFORE
Form approved omb no. 0960-0623 whose records to be disclosed name (first, middle, last, suffix) ssn - birthday - (mm/dd/yy) authorization to disclose information to the social security administration (ssa) ** please read the entire form, both...
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