Social Security Refund U.S. Citizen

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

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Social Security Refund US Citizen Download pdf
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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
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  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
University at Buffalo
Townsend Hall
205 Hayes Road
Buffalo, NY 14214

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