How to Fill Out Form SSA-44

Form SSA-44 is two pages and five steps. Most of it is straightforward — the parts that trip people up are the income figure in Step 2 and the evidence in Step 4.

Based on Form SSA-44 (12-2025) · Last reviewed 26 July 2026

Before you start

Get the current form
ssa.gov/forms/ssa-44.pdf
Current edition
SSA-44 (12-2025)
Steps to complete
5 (Step 3 is often skipped)
Questions
1-800-772-1213 · TTY 1-800-325-0778

What the five steps ask for

Form SSA-44 (12-2025) — step by step
Step What it asks Watch out for
1
Life-changing event
Tick the event that applies and enter the date it happened. Only the eight listed events qualify. Choosing to withdraw less from an IRA is not one of them.
2
Reduction in income
The tax year your income fell, your estimated adjusted gross income, your tax-exempt interest, and your filing status for that year. Tax-exempt interest counts. Municipal bond income raises the figure even though it isn't taxable.
3
Next year's income
The same figures again, for the following year — only if your income will be lower again. Leave it blank if your income drops once and then holds steady. Filling it in unnecessarily invites questions.
4
Documentation
Evidence of your modified adjusted gross income and evidence of the life-changing event. Two separate things are needed here. Sending proof of the event but not the income is the most common gap.
5
Signature
Your signature, date, phone number and mailing address. An unsigned form is returned unprocessed — the single most avoidable delay.

The exact evidence Social Security asks for

Step 4 is where requests stall. The form specifies what it wants for each event, and matching it precisely is worth the effort.

Required evidence by life-changing event
Event Evidence Form SSA-44 asks for
MarriageAn original marriage certificate, or a certified copy of a public record of marriage.
Divorce or annulmentA certified copy of the decree of divorce or annulment.
Death of your spouseA certified copy of the death certificate, of the public record of death, or of a coroner's certificate.
Work stoppageA signed statement from your employer, pay stubs, or documents showing transfer of a business. Where none is available, a signed statement made under penalty of perjury.
Work reductionThe same options as work stoppage — an employer statement is the cleanest.
Loss of income-producing propertyAn insurance adjuster's statement of loss, or a letter from a state or federal government about the uncompensated loss.
Loss of pension incomeA letter or statement from your pension fund administrator explaining the reduction or termination.
Employer settlement paymentA letter from the employer stating the settlement terms of the bankruptcy court.

Social Security returns your original documents or certified copies by post, or you can show originals at a field office and keep them with you. See where to send the form for how each route works.

Getting the income figure right

The number Social Security cares about is your modified adjusted gross income — adjusted gross income plus tax-exempt interest. That second component is what catches people out: municipal bond income never appears on your tax bill, but it counts in full here, and it can be the difference between one IRMAA bracket and the next.

Because Step 2 asks for an estimate for a year that hasn't finished, it's worth checking where your estimate actually lands before you commit it to the form. Run it through the IRMAA calculator — if the reduced figure doesn't move you into a lower bracket, filing the form won't change your premium, and you'll have your answer before spending the effort.

Four mistakes that send forms back

Once it's complete

Form SSA-44 has no national mailing address — it goes to the Social Security field office that serves your area, and you can also take it in person or call to arrange it. The routes, and what to put in the envelope, are covered on where to send Form SSA-44. For background on which events qualify and what happens after a decision, start with the SSA-44 overview.

Frequently asked questions

How do I submit Form SSA-44?

Complete all five steps, sign it, attach evidence of both the event and your estimated income, then take or mail it to your local Social Security field office. There's no national address and no published online upload — see where to send it.

Which version of the form should I use?

The current edition, SSA-44 (12-2025), downloaded from SSA.gov. Older copies circulate online.

Do I have to complete Step 3?

Only if you expect your income to be lower again the following year. Otherwise leave it blank.

What income figure do I put on the form?

Your estimated modified adjusted gross income — adjusted gross income plus tax-exempt interest.

What if I can't get formal proof of my event?

For work stoppage or reduction, the form allows a signed statement made under penalty of perjury where an employer letter isn't available. Documents still make approval more straightforward.

This page is general information, not legal or tax advice. Get the current form and its official instructions directly from Social Security at ssa.gov/forms/ssa-44.pdf.