Are you a resident of Pohnpei looking to understand the process of filing for Social Security? Applying for Social Security is an important step that should not be taken lightly, and it's essential to have a grasp on all aspects before applying. In this blog post, we'll provide an overview of the Pohnpei social security form so you can accurately complete your application and ensure all necessary information has been properly submitted. We'll also share resources available should you require further assistance or guidance at any point in the process. So if you're ready to navigate applying for Social Security with confidence, let's get started!
| Question | Answer |
|---|---|
| Form Name | Pohnpei Social Security Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | social security administration baltimore, fsmss118, fsmss118 pdf, social security benefits print out |
FSM Social Security Administration
P.O. Box L Kolonia, Pohnpei FM 96941
Tel. No. (691)
QUESTIONNAIRE
Dear Beneficiary:
Please complete this survey and submit it to our office as soon as possible. Failure to do so will result in benefit withholding. Thank you.
Retirement |
Disability |
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Surviving Spouse or |
Guardian (skip to item 4) |
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1. Are you working now? |
1. Are you working now? |
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1. Are you working ? |
yes |
no |
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yes |
no |
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yes |
no |
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If yes, since when? |
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If yes, since when? |
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If yes, since when? |
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Date |
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2. Have you remarried? |
yes |
no |
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Date |
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Date |
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3. Do you have children receiving social security benefits? |
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2. Has your condition |
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yes no |
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improved? |
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4. Are any of the children receiving social security benefits |
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yes |
no |
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married? |
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yes |
no |
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working? |
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yes |
no |
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This section for all. Do not leave blank. |
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adopted? |
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yes |
no |
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Retiree, disablility recipient, or surviving spouse died? |
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no longer live with you? |
yes |
no |
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___________________________ |
____________ |
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yes |
no |
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name of child |
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ss number |
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Who died? |
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died? |
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yes |
no |
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________________________________________ |
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___________________________ |
____________ |
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(print name) |
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name of child |
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ss number |
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_________________________ |
_____________ |
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(ss #) |
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(when?) |
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Wage Earner’s Name |
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IMPORTANT:
nThis survey form must be notarized if not signed in the presence of a representative of the FSMSSA.
nIf you are living abroad and employed, please submit along with this survey form copies of
BENEFICIARY’S DECLARATION
I understand that any false statement or misrepresentation of any fact in maintaining a right for benefits is a crime punishable under Title 53 of the FSM Code.
Beneficiary’s Printed Name:
Signature:
Authorized Representative:
Relationship to Beneficiary:
Signature:
Date:
Beneficiary Current Address:
Telephone No.:
Cell Phone No.:
Municipality:
(attach authorization slip)
How long have you been at this address?
Interviewer: