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Hr ben 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by filling out Section 2 - Employee/Retiree Information. Enter your full name, BSC ID, agency, and contact details including phone numbers and email.
- In Section 3 - Declaration, provide your date of birth, retirement date, disability date (if applicable), and health insurance provider. Ensure all statements are accurate before signing.
- If claiming a spouse, complete Section 4 with their name, SSN, date of birth, Medicare Part B date, and signature.
- Finally, in Section 5 - Authorization, sign and date the form to authorize the Social Security Administration to share necessary information with the MTA Business Service Center.
- Review all sections for completeness. Attach copies of your Medicare card and Form SSA-1099 before submitting.
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