Social Security Refund US Citizen

State employee requests a refund of prior year Social Security and Medicare tax certification.

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Completing the PDF Form

  1. Read through all pages of the document to find specific instructions if any
  2. Enter requested information into the form
  3. Print the form
  4. Get required signatures
  5. Scan a copy of the signed form for your records
  6. Send the original, completed, signed form to:         

Human Resources
120 Crofts Hall
North Campus

Need Help Completing the Form?

Amy Myszka.

Amy Myszka

Director

Benefits and Work Life Balance

Phone: 716-645-5357

Email: amyszka@buffalo.edu

Form Facts

Form Type: Downloadable, PDF document

Requirements: Adobe Reader

Updated: December 2014

Owner: State of New York Office of State Comptroller