DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS …
health plan coverage through another person, like a spouse or family member, write their name. 7. Employee’s Social Security Number: If you get group health plan coverage based on your employment, write your Social Security Number here. If you get group health plan coverage through another person, like a spouse or family member, write their ...
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Social Security Administration Form Approved OMB …
secure.ssa.govSocial Security Administration Form Approved OMB No. 0960-0686 DIRECT DEPOSIT SIGN-UP FORM (JAPAN)振込依頼書(日本国内 口座用) APPLICATION FOR PAYMENT OF UNITED STATES SOCIAL SECURITY
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES …
secure.ssa.govForm CMS-L564 (04/10) U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES FORM APPROVED OMB NO. 0938-0787 REQUEST FOR EMPLOYMENT INFORMATION From: Social Security Administration Telephone Number: Employer’s Name and Address: Date: Employee’s Name:
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secure.ssa.gov16b If you checked “Yes” on line 16a, give applicant’s legal name and trade name shown on prior application if different from line 1 or 2 above. Legal name Trade name 16c Approximate date when, and city and state where, the application was filed. Enter previous employer identification number if known.
Social Security Administration
secure.ssa.govin a job covered by the pension plan. These are called "deferred vested benefits." Private pension plan administrators must provide information about such benefits to us through the Internal Revenue Service. We provide this information about the pension plan when the individual asks for it or when a claim is filed for Social Security benefits.
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SSA 5.6.1 - Social Security Administration
secure.ssa.govSUPPLEMENTAL SECURITY INCOME (SSI) OR SPECIAL VETERANS BENEFITS (SVB) CLAIM NUMBER NAME OF WAGE EARNER OR SELF-EMPLOYED PERSON (If different from claimant.) SPOUSE'S NAME (Complete ONLY in SSI cases) CLAIM FOR (Specify type, e.g., retirement, disability, hospital /medical, SSI, SVB, etc.) SOCIAL SECURITY …
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Box - Social Security Administration
secure.ssa.govFORM SSA-1099 – SOCIAL SECURITY BENEFIT STATEMENT F • PART OF YOUR SOCIAL SECURITY BENEFITS SHOWN IN BOX 5 MAY BE TAXABLE INCOME. • SEE THE REVERSE FOR MORE INFORMATION. Box 1. Name Box 2. Beneficiary’s Social Security Number Box 6.Voluntary F ederal Income Tax Withheld Box 8. Claim Number (Use this number if you need …
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I am/We are applying for Supplemental Security Income ...
secure.ssa.govDEFERRED ABAP Preferred Language: PART I--BASIC ELIGIBILITY--Answer the questions below beginning with the first moment of the filing date month. 1. First Name, Middle Initial, Last Name 4. Social Security Number Spouse's/Parent(s) Name(s) Date of Marriage: (month, day, year) FORM SSA-8001-BK (01/2008) Destroy Prior Editions
APPOINTMENT OF REPRESENTATIVE
secure.ssa.govrepresentative may do, on the back of the "Claimant's Copy" of this form. If your representative has your permission to designate an associate, such as a clerk, other party, or entity, such as a copying service, to receive information for him or her from us about your claim(s), check the block to authorize this release.
The United States Social Security Administration
secure.ssa.govSOCIAL SECURITY ADMINISTRATION APPLICATION TO COLLECT A FEE FOR PAYEE SERVICES Form Approved OMB No. 0960-0719 I/We, as representative of the organization named below, request authorization from the Social Security Administration to collect a fee for providing payee services in accordance with section 205(j)(4)(A) of the Social Security Act.
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