The month and year you elect to begin to receive benefits will determine the amount of your monthly payments.
Reduction: depending on your date of birth, the rate of reduction can range from 19/40 to 19/56 of 1 percent times the number of months.
Selected month: the month the deceased worker died or any month before you reach FRA, provided that the month you choose is within the past 12 months.
Delay: if the deceased worker received retirement benefits before FRA, delaying receipt of reduced benefits will not necessarily increase the monthly benefit amount.
Witnesses: witnesses are required only if this certificate has been signed by mark (X).
Where to send: send or bring the completed form to your local Social Security office.
| Question | Answer |
|---|---|
| Form Name | Form SSA-4111 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 25 |
| Avg. time to fill out | 5 min |
| Edition | 11-2023 |
| Issuing agency | Social Security Administration |
| Where to send | Your local Social Security office |
| Other names | SSA-4111, SSA 4111, Form SSA-4111 |
| Official source | Form SSA-4111 (Rev 11-2023), Social Security Administration |
Ssa 4111 Form isn’t the one you’re looking for?