Ssa 1 Bk Form – Fill Out and Use This PDF

The SSA-1-BK form, officially named the Application for Retirement Insurance Benefits, is a crucial document for individuals applying for retirement, survivors, and disability insurance benefits under the Social Security Act. This comprehensive form is designed to gather all necessary information to determine eligibility for benefits, covering everything from personal identification to detailed queries about military service, work history, and marital status. For those looking to navigate their journey towards retirement or other related Social Security benefits, understanding and completing this form accurately is a key step. Ready to secure your benefits? Click the button below to get started on filling out your form.

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Ssa 1 Bk Form PDF Details

Embarking on the journey to claim retirement insurance benefits marks a significant milestone in anyone's life, and the Form SSA-1-BK stands at the core of initiating this process. The form acts as the official application for retirement insurance benefits under the Social Security Act, offering a structured pathway for individuals to assert their eligibility for not only retirement benefits but also potential health insurance coverage for the aged and disabled. Delving into the details, it becomes evident that the application covers a wide array of personal information, including but not limited to, citizenship status, work history, military service, and details about one's spouse and children which may affect the benefits. Crucially, the form also serves as a gateway for individuals to report their expectations for future earnings, thus influencing the calculation and distribution of benefits. Moreover, it touches on aspects of Medicare enrollment, underlining the form's pivotal role in facilitating access to essential healthcare services alongside retirement benefits. Navigating through the SSA-1-BK's comprehensive structure not only demands attention to detail but also a clear understanding of one's own retirement and health insurance needs, laying the groundwork for securing a stable financial and health support system in the later years of life.

Question	Answer
Form Name	Ssa 1 Bk Form
Form Length	9 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	2 min 15 sec
Other names	social security retirement application, ssa 1, form ssa 1 pdf, ssa 1 bk form

Form Preview Example

Form SSA-1-BK (03-2019) UF
Discontinue Prior Editions		Page 1 of 9
Social Security Administration	TEL	OMB No. 0960-0618

APPLICATION FOR RETIREMENT INSURANCE BENEFITS		(Do not write in this space)
APPLICATION FOR RETIREMENT INSURANCE BENEFITS

I apply for all insurance benefits for which I am eligible under Title II (Federal Old-Age, Survivors,
and Disability Insurance) and Part A of Title XVIII (Health Insurance for the Aged and Disabled)
of the Social Security Act, as presently amended.
Supplement. If you have already completed an application entitled "APPLICATION FOR
WIFE'S OR HUSBAND'S INSURANCE BENEFITS", you need complete only the circled
items. All other claimants must complete the entire form.

(a) PRINT your name

FIRST NAME, MIDDLE INITIAL, LAST NAME

(b) Check (X) whether you are

Male

Female

Enter your Social Security number

Answer question 3 if English is not your language preference. Otherwise, go to item 4.

3.	Enter the language you prefer to: Speak	Write

4.	(a) Enter your date of birth	Month, Day, Year

	(b) Enter name of city and state, or foreign country where
	you were born.

	(c) Was a public record of your birth made before you were age 5?	Yes	No	Unknown

	(d) Was a religious record of your birth made before you were age 5?	Yes	No	Unknown

5.	(a) Are you a U.S. citizen?
		Yes		No
		(Go to item 7.)		(Go to item (b).)

	(b) Are you an alien lawfully present in U.S.?	Yes		No
		Yes		No
		(Go to item (c))		(Go to item 6)

	(c) When were you lawfully admitted to the U.S.?

Enter your full name at birth if different from item 1(a)

FIRST NAME, MIDDLE INITIAL, LAST NAME

7.	(a) Have you used any other name(s)?
		Yes	No
		(Go to item (b).)	(Go to item 8.)

	(b) Other names(s) used.

8.	(a) Have you used any other Social Security number(s)?	Yes	No
		Yes	No
		(Go to item (b))	(Go to item 9.)

	(b) Enter Social Security number(s) used.

			(Over)

Form SSA-1-BK (03-2019) UF						Page 2 of 9

	Do not answer question 9 if you are one year past full retirement age or older; go to question 10.

9. (a) Are you, or during the past 14 months have you been,			Yes			No
	unable to work because of illnesses, injuries or conditions?		Yes			No


	(b) If "Yes", enter the date you became unable to work.	MONTH, DAY, YEAR

10. (a) Have you (or has someone on your behalf) ever filed an			Yes	No		Unknown
	application for Social Security, Supplemental Security		Yes	No		Unknown
	application for Social Security, Supplemental Security		(If "Yes,"	(If "No," go		(If "Unknown,"
	Income, or hospital or medical insurance under Medicare?		(If "Yes,"	(If "No," go		(If "Unknown,"
	Income, or hospital or medical insurance under Medicare?		answer (b)	to item 11.)		go to item 11.)
			answer (b)	to item 11.)		go to item 11.)
			and (c).)

	(b) Enter name of person(s) on whose Social Security record	FIRST NAME, MIDDLE INITIAL, LAST NAME
	you filed other application.

	(c) Enter Social Security number(s) of person named in (b).
	(If unknown, so indicate.)

11. (a) Were you in the active military or naval service (including			Yes			No
	Reserve or National Guard active duty or active duty for		(If "Yes," answer			(If "No," go
	training) after September 7, 1939 and before 1968?		(b) and (c).)			to item 12.)
			(b) and (c).)			to item 12.)

	(b) Enter date(s) of service		Month, Year			Month, Year
	(b) Enter date(s) of service	From:			To:
		From:			To:

	(c) Have you ever been (or will you be) eligible for monthly benefits
	from a military or civilian Federal agency? (Include Veterans		Yes			No
	Administration benefits only if you waived Military retirement pay).

12. Did you or your spouse (or prior spouse) work in the railroad industry			Yes			No
	for 5 years or more?		Yes			No
	for 5 years or more?

13. (a) Do you (or your spouse) have Social Security credits (for example			Yes			No
	based on work or residence) under another country's Social		Yes			No
	based on work or residence) under another country's Social		(If "Yes,"			(If "No," go
	Security system?		(If "Yes,"			(If "No," go
	Security system?		answer (b)			to item 14.)
			answer (b)			to item 14.)
			and (c).)

	(b) List the country(ies):

Yes

Answer question 14 only if you were born January 2, 1924, or later. Otherwise go on to question 15.

14.

(a) Are you entitled to, or do you expect to be entitled to, a pension or	Yes		No
annuity (or a lump sum in place of a pension or annuity) based on your	(If "Yes,"		(If "No," go on
work after 1956 not covered by Social Security?	(If "Yes,"		(If "No," go on
work after 1956 not covered by Social Security?	answer (b)		to item 15.)
	answer (b)		to item 15.)
	and (c).)

		MONTH		YEAR
(b) I became entitled, or expect to become entitled, beginning

		MONTH		YEAR
(c) I became eligible, or expect to become eligible, beginning

I agree to promptly notify the Social Security Administration if I become entitled to a pension, an annuity, or a lump sum payment based on my employment not covered by Social Security, or if such pension or annuity stops.

Form SSA-1-BK (03-2019) UF		Page 3 of 9

15. Have you been married?	Yes	No
15. Have you been married?	(If "Yes," answer item 16.)	(If "No," go to item 17.)
	(If "Yes," answer item 16.)	(If "No," go to item 17.)

16.(a) Give the following information about your current marriage. If not currently married, write "None" Go on to item 16(b).

Spouse's name (including maiden name)		When (Month, day, year)	Where (Name of City and State)

How marriage ended (If still in effect, write		When (Month, day, year)	Where (Name of City and State)
"Not Ended.")

Marriage performed by:	Spouse's date of birth (or age)		If spouse deceased, give date of death
Clergyman or public official
Other (Explain in "Remarks")

Spouse's Social Security number (If none or unknown, so indicate)

(b)Enter information about any other marriage if you:

•Had a marriage that lasted at least 10 years; or

•Had a marriage that ended due to death of your spouse, regardless of duration; or

•Were divorced, remarried the same individual within the year immediately following the year of the divorce, and the combined period of marriage totaled 10 years or more.

Use the "Remarks" space to enter the additional marriage information. If none, write "None." Go on to item 16 (c) if you have a child(ren) who is under age 16 or disabled or handicapped (age 16 or over and disability began before age 22); and you are divorced from the child's other parent, who is now deceased, and the marriage lasted less than 10 years.

Spouse's name (including maiden name)		When (Month, day, year)	Where (Name of City and State)

How marriage ended		When (Month, day, year)	Where (Name of City and State)

Marriage performed by:	Spouse's date of birth (or age)		If spouse deceased, give date of death
Clergyman or public official
Other (Explain in "Remarks")

Spouse's Social Security number (If none or unknown, so indicate)

(c)Enter information about any marriage if you:

•Have a child(ren) who is under age 16 or disabled or handicapped (age 16 or over and disability began before age 22); and

•Were married for less than 10 years to the child's mother or father, who is now deceased; and

•The marriage ended in divorce If none, write "None."

To whom married		When (Month, day, year)	Where (Name of City and State)

How marriage ended		When (Month, day, year)	Where (Name of City and State)

Marriage performed by:	Spouse's date of birth (or age)		If spouse deceased, give date of death
Clergyman or public official
Other (Explain in "Remarks")

Spouse's Social Security number (If none or unknown, so indicate)

Use the 'Remarks' space on page 6 for marriage continuation or explanation.

If your claim for retirement benefits is approved, your children (including adopted children and stepchildren) or dependent grandchildren (including step grandchildren) may be eligible for benefits based on your earnings record.

(Turn to Page 4)

Form SSA-1-BK (03-2019) UF

Page 4 of 9

17.List below FULL NAME OF ALL your children (including adopted children, and stepchildren) or dependent grandchildren (including step grandchildren) who are now or were in the past 6 months UNMARRIED and:

• UNDER AGE 18 • AGE 18 TO 19 AND ATTENDING SECONDARY SCHOOL OR ELEMENTARY SCHOOL FULL-TIME

• DISABLED OR HANDICAPPED (age 18 or over and disability began before age 22)

Also list any student who is between the ages of 18 to 23 if such student was both: 1. Previously entitled to Social Security benefits on any Social Security record for August 1981; and 2. In full-time attendance at a post-secondary school.

(IF THERE ARE NO SUCH CHILDREN, WRITE "NONE" BELOW AND GO ON TO ITEM 18.)

18. (a) Did you have wages or self-employment income covered under Social	Yes	No
Security in all years from 1978 through last year?
	(If "Yes," go	(If "No," answer

	to item 19.)	item (b).)

(b)List the years from 1978 through last year in which you did not have wages or self-employment income covered under Social Security.

19.Enter below the names and addresses of all the persons, companies, or government agencies for whom you have worked this year, last year, and the year before last. IF NONE, WRITE "NONE" BELOW AND GO ON TO ITEM 20.

NAME AND ADDRESS OF EMPLOYER			Work Ended
NAME AND ADDRESS OF EMPLOYER	Work Began		(If still working,
(If you had more than one employer, please list them in order beginning with your			show "Not Ended")
last (most recent) employer.)	Month	Year	Month	Year
	Month	Year	Month	Year

(If you need more space, use "Remarks".)

20.

THIS ITEM MUST BE COMPLETED, EVEN IF YOU ARE AN EMPLOYEE.

Yes

(a) Were you self-employed this year and/or last year?

(If "Yes,"

(If "No," go

answer (b).)

to item 21.)

(b) Check the year or years in

In what kind of trade or business were you self-employed?

Were your net earnings from

which you were self-

(For example, storekeeper, farmer, physician)

your trade or business $400 or

employed

more? (Check "Yes" or "No")

This Year

Yes

Last Year

Yes

21.

(a) How much were your total earnings last year?

Amount $

(b) Place an "X" in each block for EACH MONTH of last year in which you did not

NONE

ALL

earn more than *$

in wages, and did not perform substantial

services in self-employment. These months are exempt months. If no months

Jan.

Feb.

Mar.

Apr.

were exempt months, place an "X" in "NONE". If all months were exempt months,

place an "X" in "ALL".

May

Jun.

Jul.

Aug.

*Enter the appropriate monthly limit after reading the instructions, "How Work

Sept.

Oct.

Nov.

Dec.

Affects Your Benefits".

Form SSA-1-BK (03-2019) UF

Page 5 of 9

22.

(a) How much do you expect your total earnings to be this year?

Amount $

(b) Place an "X" in each block for EACH MONTH of this year in which you did not or

will not earn more than *$ in wages, and did not or will not perform substantial services in self-employment. These months are exempt months. If no months are or will be exempt months, place an "X" in "NONE". If all months are or will be exempt months, place an "X" in "ALL".

*Enter the appropriate monthly limit after reading the instructions, "How Work Affects Your Benefits".

NONE

Jan.	Feb.

May	Jun.


Sept.	Oct.

	ALL

Mar.		Apr.

Jul.		Aug.

Nov.		Dec.

Answer this item ONLY if you are now in the last 4 months of your taxable year (Sept., Oct., Nov., and Dec., if your taxable year is a calendar year).

23. (a) How much do you expect to earn next year?			Amount $

	(b) Place an "X" in each block for EACH MONTH of next year in which you do not			NONE			ALL
	expect to earn more than *$	in wages, and do not expect to perform

	substantial services in self-employment. These months will be exempt months.			Jan.	Feb.	Mar.		Apr.
	If no months are expected to be exempt months, place an "X" in "NONE". If all

	months are expected to be exempt months, place an "X" in "ALL".			May	Jun.	Jul.		Aug.
	*Enter the appropriate monthly limit after reading the instructions, "How Work
				Sept.	Oct.	Nov.		Dec.
	Affects Your Benefits".			Sept.	Oct.	Nov.		Dec.
	Affects Your Benefits".

24. If you use a fiscal year, that is, a taxable year that does not end December 31 (with income tax return due April 15), enter

here the month your fiscal year ends.

(Month)

DO NOT ANSWER ITEM 25 IF YOU ARE FULL RETIREMENT AGE AND 6 MONTHS OR OLDER. YOU MAY HAVE MORE FILING OPTIONS; A SOCIAL SECURITY REPRESENTATIVE WILL CONTACT YOU TO DISCUSS ADDITIONAL INFORMATION THAT MAY HELP YOU DECIDE WHEN TO START YOUR BENEFIT. GO TO ITEM 26.

PLEASE READ CAREFULLY THE INFORMATION ON THE BOTTOM OF PAGE 9

AND ANSWER ONE OF THE FOLLOWING ITEMS:

25.

(a)

(b)

(c)

I want benefits beginning with the earliest possible month, and will accept an age-related reduction.

I am full retirement age (or will be within 12 months), and want benefits beginning with the earliest possible month providing there is no permanent reduction in my ongoing monthly benefits.

I want benefits beginning with

MEDICARE INFORMATION

If this claim is approved and you are still entitled to benefits at age 65, or you are within 3 months of age 65 or older you could automatically receive Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage at age 65. If you live in Puerto Rico or a foreign country, you are not eligible for automatic enrollment in Medicare Part B, and you will need to contact Social Security to request enrollment.

COMPLETE ITEM 26 ONLY IF YOU ARE WITHIN 3 MONTHS OF AGE 65 OR OLDER

Medicare Part B (Medical Insurance) helps cover doctor's services and outpatient care. It also covers some other services that Medicare Part A does not cover, such as some of the services of physical and occupational therapists and some home health care. If you enroll in Medicare Part B, you will have to pay a monthly premium. The amount of your premium will be determined when your coverage begins. In some cases, your premium may be higher based on information about your income we receive from the Internal Revenue Service. Your premiums will be deducted from any monthly Social Security, Railroad Retirement, or Office of Personnel Management benefits you receive. If you do not receive any of these benefits, you will get a letter explaining how to pay your premiums. You will also get a letter if there is any change in the amount of your premium.

If you do not sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty for as long as you have Part B. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but did not sign up for it. Also, you may have to wait until the General Enrollment Period (January 1 to March 31) to enroll in Part B, and coverage will start July 1 of that year.

You can also enroll in a Medicare prescription drug plan (Part D). To learn more about the Medicare prescription drug plans and when you can enroll, visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048). Medicare can also tell you about agencies in your area that can help you choose your prescription drug coverage. The amount of your premium varies based on the prescription drug plan provider. The amount you pay for Part D coverage may be higher than the listed plan premium, based on information about your income we receive from the Internal Revenue Service.

If you have limited income and resources, we encourage you to apply for the Extra Help that is available to assist you with Medicare prescription drug costs. The Extra Help can pay the monthly premiums, annual deductibles, and prescription co- payments. To learn more or apply, please visit www.socialsecurity.gov, call 1-800-772-1213 (TTY 1-800-325-0778) or visit the nearest Social Security office.

Form SSA-1-BK (03-2019) UF			Page 6 of 9

26.	Do you want to enroll in Medicare Part B (Medical insurance)?	Yes	No

27.	If you are within 2 months of age 65 or older, blind or disabled,	Yes	No
	do you want to file for Supplemental Security Income?

REMARKS (You may use this space for any explanations. If you need more space, attach a separate sheet.)

Form SSA-1-BK (03-2019) UF	Page 7 of 9

I declare under penalty of perjury that I have examined all the information on this form, and on any accompanying statements or forms, and it is true and correct to the best of my knowledge. I understand that anyone who knowingly gives a false statement about a material fact in this information, or causes someone else to do so, commits a crime and may be subject to a fine or imprisonment.

SIGNATURE OF APPLICANT

SIGNATURE (First Name, Middle Initial, Last Name) (Write in ink.)

Date (Month, day, year)

Telephone number(s) at which you may be contacted during the day

Direct Deposit Payment Information (Financial Institution)

Routing Transit Number	Account Number	Checking	Enroll in Direct Express
		Checking	Enroll in Direct Express
		Savings	Direct Deposit Refused

Applicant's Mailing Address (Number and street, Apt No., P.O. Box, or Rural Route) (Enter Residence Address in "Remarks," if different.)

City and State

ZIP Code

County (if any) in which you now live

Witnesses are required ONLY if this application has been signed by mark (X) above. If signed by mark (X), two witnesses who know the applicant must sign below, giving their full addresses. Also, print the applicant's name in the Signature block.

1. Signature of Witness

2. Signature of Witness

Address (Number and Street, City, State and ZIP Code)

Form SSA-1-BK (03-2019) UF	Page 8 of 9

RECEIPT FOR YOUR CLAIM FOR SOCIAL SECURITY RETIREMENT INSURANCE BENEFITS

TELEPHONE

NUMBER(S) TO CALL IF YOU HAVE A QUESTION OR SOMETHING TO REPORT

BEFORE YOU RECEIVE A NOTICE OF AWARD

AFTER YOU RECEIVE A NOTICE FOF AWARD

SSA OFFICE

DATE CLAIM RECEIVED

Your application for Social Security benefits has been received		there is some other change that may affect your claim, you - or
		someone for you - should report the change. The changes to be
and will be processed as quickly as possible.
and will be processed as quickly as possible.		reported are listed on page 9.
		reported are listed on page 9.
You should hear from us within	days after you have	Always give us your claim number when writing or telephoning

given us all the information we requested. Some claims may
given us all the information we requested. Some claims may		about your claim.
take longer if additional information is needed.		about your claim.
take longer if additional information is needed.
In the meantime, if you change your address, or if		If you have any questions about your claim, we will be glad to
In the meantime, if you change your address, or if		help you.
		help you.

CLAIMANT		SOCIAL SECURITY CLAIM NUMBER

Privacy Act Statement

Collection and Use of Information

Sections 202, 205, and 223 of the Social Security Act, as amended, allow us to collect this information. Furnishing us this information is voluntary. However, failing to provide all or part of the information may prevent us from making an accurate and timely decision concerning your or a dependent’s eligibility to benefit payments.

We will use the information you provide to help us determine your or a dependent’s eligibility for benefit payments. We may also share the information for the following purposes, called routine uses:

1.To contractors and other Federal agencies, as necessary, for the purpose of assisting the Social Security Administration (SSA) in the efficient administration of its programs.

2.To student volunteers, individuals working under a personal services contract, and other workers who technically do not have the status of Federal employees, when they are performing work for SSA, as authorized by law, and they need access to personally identifiable information in SSA records in order to perform their assigned agency functions.

In addition, we may share this information in accordance with the Privacy Act and other Federal laws. For example, where authorized, we may use and disclose this information in computer matching programs, in which our records are compared with other records to establish or verify a person’s eligibility for Federal benefit programs and for repayment of incorrect or delinquent debts under these programs.

A list of additional routine uses is available in our Privacy Act System of Records Notices (SORN) 60-0059, entitled Earnings Recording and Self-Employment Income System and 60-0089, entitled Claims Folders System. Additional information and a full listing of all our SORNs are available on our website at www.socialsecurity.gov/foia/bluebook.

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control number. We estimate that it will take about 11 minutes to read the instructions, gather the facts, and answer the questions. SEND OR BRING THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. You can find your local Social Security office through SSA’s website at www.socialsecurity.gov. Offices are also listed under U. S. Government agencies in your telephone directory or you may call Social Security at 1-800-772-1213

(TTY 1-800-325-0778). You may send comments on our time estimate above to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401. Send only comments relating to our time estimate to this address, not the completed form.

Form SSA-1-BK (03-2019) UF

Page 9 of 9

CHANGES TO BE REPORTED AND HOW TO REPORT

Failure to report may result in overpayments that must be repaid, and in possible monetary penalties

•You change your mailing address for checks or residence. (To avoid delay in receipt of checks you should ALSO file a regular change of address notice with your post office.)

•Your citizenship or immigration status changes.

•You go outside the U.S.A. for 30 consecutive days or longer.

•Any beneficiary dies or becomes unable to handle benefits.

•Work Changes - On your application you told us you expect

total earnings for				to be $	.
		(Year)
		(Year)
You	(are)	(are not) earning wages of more than
$			a month.

You (are) (are not) self-employed rendering substantial services in your trade or business.

(Report AT ONCE if this work pattern changes)

•You are confined to a jail, prison, penal institution or correctional facility for more than 30 continuous days for conviction of a crime, or you are confined for more than 30 continuous days to a public institution by a court order in connection with a crime.

•You have an unsatisfied warrant for more than 30 continuous days for your arrest for a crime or attempted crime that is a felony of flight to avoid prosecution or confinement, escape from custody and flight-escape. In most jurisdictions that do not classify crimes as felonies, this applies to a crime that is punishable by death or imprisonment for a term exceeding one year (regardless of the actual sentence imposed).

•You have an unsatisfied warrant for more than 30 continuous days for a violation of probation or parole under Federal or State law.

•You become entitled to a pension, an annuity, or a lump sum payment based on your employment not covered by Social Security, or if such pension or annuity stops.

•Your stepchild is entitled to benefits on your record and you and the stepchild's parent divorce. Stepchild benefits are not payable beginning with the month after the month the divorce becomes final.

•Custody Change - Report if a person for whom you are filing or who is in your care dies, leaves your care or custody, or changes address.

•Change of Marital Status - Marriage, divorce, annulment of marriage.

•If you become the parent of a child (including an adopted child) after you have filed your claim, let us know about the child so we can decide if the child is eligible for benefits. Failure to report the existence of these children may result in the loss of possible benefits to the child(ren).

HOW TO REPORT

You can make your reports online, by telephone, mail, or in person, whichever you prefer.

If you are awarded benefits, and one or more of the above change(s) occur, you should report by:

•Visiting the section "my Social Security" at our web site at www.socialsecurity.gov.

•Calling us TOLL FREE at 1-800-772-1213.

•If you are deaf or hearing impaired, calling us TOLL FREE at TTY 1-800-325-0778; or

• Calling, visiting or writing your local Social Security office at the phone number and address shown on your claim receipt.

For general information about Social Security, visit our web site at www.socialsecurity.gov.

For those under full retirement age, the law requires that a report of earnings be filed with SSA within 3 months and 15 days after the end of any taxable year in which you earn more than the annual exempt amount. You may contact SSA to file a report. Otherwise, SSA will use the earnings reported by your employer(s) and your self-employment tax return (if applicable) as the report of earnings required by law, to adjust benefits under the earnings test. It is your responsibility to ensure that the information you give concerning your earnings is correct. You must furnish additional information as needed when your benefit adjustment is not correct based on the earnings on your record.

PLEASE READ THE FOLLOWING INFORMATION CAREFULLY BEFORE YOU ANSWER QUESTION 25.

•If you are under full retirement age, retirement benefits cannot be payable to you for any month before the month in which you file your claim.

•If you are over full retirement age, retirement benefits may be payable to you for some months before the month in which you file this claim.

•If your first month of entitlement is prior to full retirement age, your benefit rate will be reduced. However, if you do not actually receive your full benefit amount for one or more months before full retirement age because benefits are withheld due to your earnings, your benefit will be increased at full retirement age to give credit for this withholding. Thus, your benefit amount at full retirement age will be reduced only if you receive one or more full benefit payments prior to the month you attain full retirement age.

•Delayed retirement credits may be added to your benefits if you request them to start when you are full retirement age or older.

•Please visit our www.ssa.gov web site to use the Retirement Estimator to get a personal estimate of how much your benefits will be at different ages. In addition, our web site provides information about other things you should think about when you make your decision about when to begin your benefits.

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2. The third part would be to complete these particular blank fields: you were born, c Was a public record of your, d Was a religious record of your, a Are you a US citizen, Yes, Yes, Yes, Unknown, Unknown, Go to item, Go to item b, Yes, Go to item c, Go to item, and b Are you an alien lawfully.

3. Completing a Have you used any other Social, b Enter Social Security numbers, Yes, Go to item b, Go to item, and Over is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

ssa 1 bk form conclusion process described (step 3)

4. Your next subsection will require your input in the following areas: a Are you or during the past, unable to work because of, Yes, b If Yes enter the date you became, MONTH DAY YEAR, a Have you or has someone on your, application for Social Security, Yes, If Yes answer b and c, No If No go to item, Unknown If Unknown go to item, b Enter name of persons on whose, FIRST NAME MIDDLE INITIAL LAST NAME, you filed other application, and c Enter Social Security numbers of. Make sure that you fill in all of the required information to go forward.

No If No go to item, you filed other application, and c Enter Social Security numbers of of ssa 1 bk form

As for No If No go to item and you filed other application, make sure that you take another look in this section. Both of these are certainly the most important fields in the page.

5. To wrap up your document, this last section incorporates a number of extra blanks. Entering Did you or your spouse or prior, a Do you or your spouse have, based on work or residence under, b List the countryies, Yes, If Yes answer b and c, No If No go to item, c Are you or your spouse filing, Yes, Answer question only if you were, a Are you entitled to or do you, annuity or a lump sum in place of, b I became entitled or expect to, c I became eligible or expect to, and Yes If Yes answer b and c should conclude everything and you'll be done in a short time!

Step 3: Proofread what you have entered into the blank fields and press the "Done" button. Get the printable social security retirement application as soon as you subscribe to a 7-day free trial. Easily use the pdf in your FormsPal account, with any modifications and adjustments being all preserved! At FormsPal.com, we do our utmost to be sure that all of your information is stored protected.

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