SOP_NUMBER: 503.02-att-1
TITLE: Certification of Prison Records
REFERENCE_CODE: VK01-0002
DIVISION: Unknown
TOPIC_AREA: Reentry
WORD_COUNT: 184
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/547579
URL: https://gps.press/sop-data/503.02-att-1/

SUMMARY:
This form is used by Georgia Department of Corrections staff to certify and verify an inmate's identifying information from their official prison record for submission to the Social Security Administration. A counselor completes this certification to accompany the inmate's application for a replacement Social Security card, confirming that the personal details provided are accurate based on the inmate's institutional file.

KEY_TOPICS: Social Security card, Social Security Number, inmate records, reentry, identification verification, SSA application, prison records certification, TOPPSTEP, counselor certification, personal identifying information

ATTACHMENTS:
  1. Certification of Prison Records
     URL: https://gps.press/sop-data/503.02-att-1/
  2. Consent for Release of Information (SSA-3288 Form)
     URL: https://gps.press/sop-data/503.02-att-2/
  3. TOPPSTEP Checklist
     URL: https://gps.press/sop-data/503.02-att-3/
  4. Authorization for Submission of Information to Obtain Georgia Driver's License or Identification Card
     URL: https://gps.press/sop-data/503.02-att-4/
  5. Reentry Checklist Narrative for State Prisons and Transitional Centers
     URL: https://gps.press/sop-data/503.02-att-5/
  6. Residence Verification Form: Georgia Department of Community Supervision, Department of Corrections, and/or Board of Pardons and Paroles
     URL: https://gps.press/sop-data/503.02-att-6/
  7. Problem Housing File Review
     URL: https://gps.press/sop-data/503.02-att-7/

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FULL TEXT:
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# **GEORGIA DEPARTMENT OF CORRECTIONS**

_**Prison**_
_**Prison Address**_


_**Warden’s Name**_

_**Warden**_

Brian P. Kemp Timothy C. Ward
_Governor_ _Commissioner_


**CERTIFICATION OF PRISON RECORDS**

DATE: ________________________________________

INMATE NAME: _______________________________

INMATE ID: ___________________________________

SOCIAL SECURITY NUMBER: ___________________

SOCIAL SECURITY ADMINISTRATION
Street address
City, State and Zip

Attached please find a completed Form SS-5 (Application for Social Security Number) requesting a replacement
Social Security Number card for the above named individual.

I, the undersigned, certify that I have reviewed appropriate documents in the above named inmate’s official prison
record and that the identifying information shown below is accurate to that record:

NAME_________________________________________________________________________

DATE OF BIRTH: _______________________________________________________________

PLACE OF BIRTH: ______________________________________________________________

MOTHER’S MAIDEN NAME: _____________________________________________________

FATHER’S NAME: ______________________________________________________________

Other Names used by Inmate: Other Social Security Numbers used by Inmate:

______________________________ _______________________________

______________________________ _______________________________

______________________________ ________________________________

______________________________ _______________________________

If you have any further questions, please contact me between the hours of 8:00 am to 4:00 pm.
My telephone number is ___________________.
_______________________________
Printed name of Counselor

_______________________________
Signature
OMB Control Number 0960-0688


Retention Schedule: Upon completion, this form shall be placed in the TOPPSTEP packet in the offender’s institutional
file, and the file shall be retained according to the official retention schedule for that file.