Complete this form only if you want the Social Security Administration to give information or records about you to an individual or group (for example, a doctor, or an insurance company). Do not use this form to request information about your earnings or employment history. To do this, complete Form SSA-7050-F4. You can get this form at any Social Security office. This consent form must be completed and signed only by: the person to whom the information or record applies, or the parent or legal guardian of a minor to whom the nonmedical information applies, or the legal guardian of a legally incompetent adult to whom the information applies. |