Applicant requests for DHS information should be submitted on DHS Form G-639 . DO's may obtain a supply of these forms by regular requisition and, when necessary,
may assist the applicant in completing the form.
When requesting the DHS information,
Enter all pertinent identifying information on the Form G-639
|The DHS information is to be returned to SSA
||Enter DO's name and address in the box above item 1 of the Form G-639
|The applicant needs information from the file of another person (e.gt., relative,
||Be sure that the “consent block” of Form G-639 is signed by the person to whom the record pertains (if living).
Submit the required fee ($15.00) or request waiver of the fee.