[Institution Letterhead]

                                                                                      [date]

Social Security Administration

[Local office address]

 

Dear [name]

Pursuant to procedures contained in the Memorandum of Understanding between our agencies, I hereby authorize the following [Name of facility] staff to submit inmate applications for replacement SSN cards to your office and certify the identifying information found in inmates’ official prison records:

 

                              [Signature]___________________________________

                              [Print name. position]

 

                              [Signature]____________________________________

                              [Print name, position]

 

                              [Signature]____________________________________

                              [Print name, position]

 

                              [Signature]____________________________________

                              [Print name, position]

 

Please contact me at [telephone number] if you have any questions.

 

                                                                 Sincerely,

                                                                 ___________________________

                                                                 [Signature]

                                                                 ___________________________

                                                                 [Printed Name]

                                                                 ___________________________

                                                                 [Warden or Similar Official]

 

                       [Institution Letterhead

 

CERTIFICATION OF PRISON RECORDS

 

                                                                 DATE: __________________________

                                                                  NAME: ____________________

                                                                 INMATE ID #: ___________________

                                                                 SOCIAL SECURITY #: ____________________

 

Social Security Administration

(address)

(locations

 

 

Attached, please find a completed Form SS-5 (Application for Social Security Number) requesting a replacement Social Security number card for the above named individual.

 

I, the undersigned, certify that I have reviewed the above inmate's official prison record and that the identifying information shown below is accurate according to that record.

 

                         NAME: ____________________________________________

                         DATE OF BIRTH: __________________________________

                         PLACE OF BIRTH: _________________________________

                         MOTHER’S MAIDEN NAME: ________________________

                         FATHER’S NAME: __________________________________

 

 

If you have any further questions, please contact me between the hours of ______ to ______. My telephone number is _____________.

 

 

 

 

                                                                      ______________________________________

                                                                      signature
                                                                      typed name for authorized official
                                                                       prison name, city

 

                                                                                OMB Control Number 0960-0688

                                                  [Institution Letterhead]

                                                        Day/Month/Year

 

Social Security Administration

Attn: [Appropriate Official Name & Title]

Address

City, State ZIP Code

 

Dear [Name]:

 

Pursuant to procedures contained in the Memorandum of Understanding between our agencies, we are enclosing recently completed SS-5 applications for replacement Social Security Number cards for the following inmates:

                 ________________________________________________

                 ________________________________________________

                 ________________________________________________

                 ________________________________________________

                 ________________________________________________

                 ________________________________________________

 

Each SS-5 is accompanied by a signed SSA-3288, along with a completed Certification of Records form.

If you require additional information, please do not hesitate to contact us. Thank you for your assistance in this matter.

 

                                                                     Sincerely,

 

____________________________________

                                                                     typed name for authorized official

                                                                      position