Social Security

The Social Security Administration has the responsibility of enrolling people who are turning 65 into Medicare and for collecting Medicare premiums. For any other information about Medicare, please try the official web page or the Centers for Medicare & Medicaid Services site.

If you have questions not answered on the Social Security Administration web page, please contact the agency at 1-800-772-1213 or visit your local Social Security Administration office.

To make an inquiry concerning the status of a claim filed with the Social Security Administration, non-receipt of benefit payments, or other problems with the Social Security Administration, my office must have permission from the constituent in the form of a signed Privacy Act Release Form from the constituent, or the Representative Payee on their Social Security record.

Constituents may reach out to my office for casework assistance via my webpage or phone. Visitors to my office must have a scheduled appointment in order to meet with my staff.

Your Contact Information

Title*

First Name*

Middle Name

Last Name*

Suffix

Gender

Date of Birth

Email Address

Please Verify Email Address

Phone Number *

Home, work, mobile, other.

Secondary Phone Number

Home, work, mobile, other.

Street Address or P.O. Box*

Street Address (2)

City*

County of Residence *

State*

Zip Code*

Do you have a different mailing address?

Case Details

Which government agency (or agencies) have you been working with? *

Claimant's Social Security No. *

Social Security No. format: XXX-XX-XXXX

If this is Medicare issue, please include your Medicare Beneficiary Identifier (MBI)

Medicare Beneficiary Identifier format: XXXX-XXX-XXXX

Have you contacted another Congressional office? *

Your Request

What do you need help with? *

Please describe the problem in as much detail as necessary.

Is there anything else that Senator Durbin or his staff needs to know?

I am filling out this form for myself only, not family, friends, or others. *

I certify, under penalty of perjury, that 1) I provided or authorized all of the information in this privacy release and any document submitted with it; 2) I reviewed and understand all of the information contained in my privacy release and submitted with it; and 3) all of this information is complete, true, and correct. *

* The SSA recognizes Representative Payee but does not recognize Power of Attorney.

Preview and Send Request

Once you have reviewed your information, press the Print Privacy Release Form button. This will generate a PDF containing all of the information you have entered as well as a privacy release form. Please print the form, sign and date the last page, and return the form in its entirety to the Senator's office by fax or mail.

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Thank you for contacting me. The information on your form has been submitted electronically to my office. A PDF of your form is being generated automatically and should be ready within 10 seconds. If one is not available to download in that time, click here.

Once we have received your signed authorization, my staff will begin assessing how we can help. Please allow up to 30 days from the day we receive your release for my office to contact you. Thank you.

Senator Dick Durbin

Social Security

Preview and Send Request

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