Are you getting ready to retire from Social Security? If so, you may be aware that the SSA 4290 F4 Form is a critical part of your application package. This form establishes your eligibility for Social Security retirement benefits, and it's important that you understand how to fill it out accurately in order to ensure the most positive outcome possible. In this blog post, we'll provide an in-depth look at the SSA 4290 F4 Form - what it is, why you need it and how to properly complete it - so that you can gain a better understanding of this crucial document before submitting your application. Let's get started!
Question | Answer |
---|---|
Form Name | Ssa 4290 F4 Form |
Form Length | 1 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 15 sec |
Other names | OMB, ssa 4290, Page1, 01r |
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Form Approved |
SOCIAL SECURITY ADMINISTRATION |
OMBNo. |
DEVELOPMENT OF PARTICIPATION IN A
VOCATIONAL REHABILITATION OR SIMILAR PROGRAM
Part I
Section A
1. Beneficiary's |
Name |
(Last, First, MI) |
2. Beneficiary's |
Date |
3. Type of claim |
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of Birth |
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r 01r 551 r Concurrent |
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4. Beneficiary's |
Social |
Security Number |
5. Wage |
Earner's |
Social Security Number |
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(if different |
from Beneficiary's) |
6.Beneficiary's address (Number & Street, City, State, Zip Code)
7.Beneficiary reports that he/she is receiving vocational rehabilitation services, employment services, or other support services from (check one):
An Employment Network under an Individual Work Plan (IWP)
A State Vocational Rehabilitation agency under an Individualized Plan for
Employment (IPE)
Other provider of services under an individualized, written employment plan similar to an IPE
An educational institution under an Individualized Education Program (IEP) to beneficiary age 18 through 21 years
8.Name, address and telephone number of a contact person in the organization/agency identified above:
Section B
9. Signature of Person Who Completed Part I: |
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10. Title: |
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11. |
Date: |
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12. DDS |
or Fa Code: |
13. |
Telephone |
number |
( |
) |
- |
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(include area |
code): |
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Form |
Page1 |