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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the name of the wage earner, self-employed person, or SSI claimant in the designated field.
  3. Next, input the Social Security Number associated with the claimant in the appropriate section.
  4. If you are not the wage earner or claimant, provide your name and relationship to them in the specified fields.
  5. Review all entered information for accuracy before proceeding to sign. Ensure that you understand the certification statement provided.
  6. Sign your name in ink as required and date it appropriately. Include your telephone number and mailing address.
  7. If applicable, have two witnesses sign below if you signed by mark (X), providing their full addresses as well.

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