Social Security Forms Printable

For withholding from social security benefits the claim number is the social security number under which a claim is filed or benefits are paid for example 123 45 6789a or 123 45 6789b6.

Social security forms printable. Or contact your local social security office. B enter name of persons on whose social security record you filed other application. The social security act as amended 42 usc. If you receive any government payment shown below you may use this form to ask the payer to withhold federal income tax.

1395o 1395s and 1395ii for your enrollment in medicare part b. Sections 205c and 702 of the social security act as amended authorize us to collect this information. Unemployment compensation including railroad unemployment insurance act ruia payments social security benefits social security equivalent tier 1 railroad retirement benefits commodity credit corporation loans. Many forms must be completed only by a social security representative.

However failure to provide the requested. When we make a decision on your claim we send you a letter explaining our decision. Once you complete section a. Fillable and printable social security forms 2020.

Employees social security number. If you do not agree with our decision you can appealthat is ask us to look at your case again. The information you furnish on this form is voluntary. The information you provide will be used to assign you a social security number and issue a social security card.

Social security and the centers for medicare medicaid services cms need your information to determine if youre entitled to part b. Once section a is completed give this form to your employer to complete section b. Please call us at 1 800 772 1213 tty 1 800 325 0778 monday through friday between 7 am. The letter or letternumber combination suffix that follows the claim number identifies the type of benefit for example a wage earner a spouse or a.

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. If you get group health plan coverage based on your employment write your social security number here.