SSA helps claimants who are unable to pursue their claims and obtain needed evidentiary documents through their own efforts. We do this by preparing letters for claimants to custodians of records. The FO uses Form SSA-L106-F3 (Letter to Custodian of School Records) to assist the claimant in securing a school record in these situations.

See GN 00301.195 for general instructions on preparing requests for documents. See OS 15010.119 for an exhibit of the SSA-L106-F3. Complete items on the form SSA-L106-F3 as follows.

1. 1. 

   Claim Number and Date

2. 2. 

   Part 1 – To Be Completed By Requester

   1. a. 

      Enter the record custodian’s name and address.

   2. b. 

      Complete the identifying information. If the child lived with someone other than a parent or guardian, give the name of that person and the relationship, if any.

   3. c. 

      Provide the school attendance information. If the claimant does not remember the exact information requested, give the best description the claimant can supply, using the remarks section if necessary.

   4. d. 

      Use the remarks section to furnish any other pertinent information known to the claimant (e.g., names of teachers, names of siblings in school at the same time).

   5. e. 

      Have the claimant authorize disclosure of the requested information to SSA, sign his/her name, provide his/her phone number, and indicate his/her relationship (e.g., self) to the person whose record is being requested.

3. 3. 

   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.

4. 4. 

   Part 3 – Payment Information

   Indicate the fee amount and the payment method. Specify that no fee is required, if applicable.

5. 5. 

   Part 4 – Certification by Custodian of School Records

   The records custodian completes this part of the form. 

If the mailing address of the custodian is known, prepare an envelope for the applicant to mail the form to the custodian. If there is doubt about the address of the custodian, send the form by SSA-562-U3 to the parallel FO for mailing.