TN 21 (05-06)

GN 00301.115 Forms Used for Certification of Contents of Documents or Public Records

A. Preview

This section contains policy and procedure for Forms SSA-704-F3, SSA-533, SSA-4385, and SSA-768 respectively.

B. Policy

1. General

All certification forms must be completed by authorized employees (see GN 00301.090). In addition, for the SSA-704-F3, certifications duly executed by a U.S. Consular employee are acceptable regardless of the type of form used.

2. When to Use

  1. To certify the contents of English-language documents when the documents to be returned to the claimant cannot be photocopied. However, see NOTE in GN 00301.090A.1.b. for exception.

  2. To certify records in the custody of a public custodian.

  3. To do extract translations of foreign language records and documents prepared by an SSA translator who is also authorized to certify documents (see GN 00301.090 and GN 00301.340).

    NOTE: A properly certified photocopy of the document being translated is still required unless the document is in the custody of a public custodian or cannot otherwise be photocopied.

3. When Not to Use

The evidence is being secured in connection with prosecution.

C. Procedure - SSA-704-F3 (Certification of Contents of Document(s) or Record(s))

  • Use to certify records of age, relationship, citizenship, marriage, death, military service, and to evaluate a family bible or other family record.

    NOTE:  State Record Custodians may use Form SSA-704-F3 to certify evidence for SSA purposes. The completed form must be given to SSA directly by the State Record Custodian.

  • May be used to certify and translate foreign language documents by SSA authorized translators who are also authorized to certify documents under GN 00301.090.

  • Do not use to certify court records (see GN 00301.115E.).

D. Procedure - SSA-533 (Translation Request)

  • All employees can use this form to route foreign language documents for translation (see GN 00301.365.)

  • SSA authorized translators can use this form to certify/translate foreign language documents (SSA-533-FC in OIO);

NOTE: SSA employees who are authorized translators can use the SSA-533 to certify foreign-language documents even though the translator is not an authorized SSA certifier under GN 00301.090.

E. Procedure - SSA-4385 (Certification of Contents of Court Records)

1. General - When to Use

  1. Claims representative trainees or higher grade claims employees may use to certify the contents of the following court records when the record cannot be photocopied:

    • Divorce;

    • Annulment;

    • Adoption;

    • Guardianship, etc.

  2. Certify/translate foreign language court records if they are authorized translators.

2. Reference

See GN 00301.430B. for special rules that apply to extract translations of court decrees.

F. Procedure - SSA-768 (Certification of Evidence of Wages)

  • Use to establish wages.

  • Follow the procedure in RS 01403.043D.2. when Form W-2 (Withholding Statement) cannot be recorded electronically on an MCS claim.

G. Exhibits

For exhibits of these forms refer to OS 15010.000.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0200301115
GN 00301.115 - Forms Used for Certi