TN 21 (12-05)
GN 00302.070 How to Complete Form SSA-L706 (Letter to Custodian of Birth Records)
Claimants normally have the responsibility for furnishing the proofs that are necessary to support their claims. SSA, however, recognizes the obligation to help claimants who are unable to prosecute their claims and obtain needed documents through their own efforts.
One way SSA helps is by preparing letters for claimants to custodians of records and documents.
When a birth or religious record is needed for proof of age and the claimant needs assistance, the FO will complete the SSA-L706 (Letter to Custodian of Birth Records) for the claimant's signature.
NOTE: FOs may also use this form to obtain birth record verifications or certifications (e.g., when required by instructions in RM 10210.250). Complete only the applicable entries (e.g., there will be no entry in the claim number field if you are verifying a birth record for a Social Security number card).
C. Letter to Custodian of Birth Records (Form SSA-L706)
For an exhibit of Form SSA-L706, see OS 15010.331
D. Procedure – Completion of the Form
Claim Number and Date
Be sure to enter both items. Indicate whether the custodian of the record should return the completed form to the requester or to SSA. Complete the form carefully and completely.
Part 1 – To Be Completed by Requester
Circle who is trying to establish a date of birth and the type of record requested.
Indicate whether the request for information is based on the data entered on the form or on an attached document.
Complete the individual’s name at birth, date and place of birth, and the parents’ names.
Be sure the claimant authorizes disclosure of the information to SSA if the form indicates the record custodian should reply directly to SSA.
The requester should sign the form, print his/her name, provide his/her relationship to the person whose record is being requested (e.g., self, authorized applicant), and provide his/her address and phone number.
Part 2 – Notarization of Requester’s Signature (If Required)
Space is provided for a Notary Public’s notarization and seal. The FO should determine whether the record custodian requires requests to be notarized and advise the requester about whether notarization is needed.
Part 3 – Payment Information
Indicate the fee amount and the payment method. Specify that no fee is required, if applicable.
Part 4 – Completed by SSA Official to Indicate Return Address/to Verify Requester’s Identity
If SSA is the requester, if the requester authorized disclosure to SSA, or if SSA must verify the requester’s identity, SSA should complete this section.
If the record custodian requires verification of the requester’s identity, the FO should verify his/her identity and enter the evidence used to verify it.
Part 5 – To Be Completed by Records Custodian or Official
The records custodian completes this part of the form.
IMPORTANT: Have the applicant sign the form where indicated.
NOTE: If the record is expected to show a name other than the worker’s current name, enter the worker’s name on the return envelope.
See GN 00301.195 for general instructions on preparing requests for documents, including instructions about return envelopes.