Form SSA-4111 (04-2019) UF-2026

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The document is Form SSA-4111, a Certificate of Election for Reduced Widow(er)'s and Surviving Divorced Spouse's Benefits issued by the Social Security Administration. It outlines the requirements and implications for individuals aged 62 or older who wish to receive reduced benefits as a widow, widower, or surviving divorced spouse. The form includes instructions on how to complete it, details on how benefits may be affected based on various factors, and privacy information regarding the collection and use of personal data.
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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the name of the wage earner or self-employed person in the first field, followed by their Social Security Number.
  3. Next, print your full name in the designated area and provide your own Social Security Number.
  4. In section 3, select the month and year you wish to begin receiving reduced benefits. Ensure this date is within the past 12 months from your full retirement age.
  5. Sign and date the form at the bottom, ensuring all information is accurate. If you are signing by mark (X), two witnesses must sign below with their addresses.
  6. Review all entries for accuracy before saving or exporting your completed form for submission.

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A widow, widower, or surviving divorced spouse cannot apply online for survivors benefits. You should contact us at 1-800-772-1213 to request an appointment. If you are deaf or hard of hearing, call our TTY number at 1-800-325-0778.
Who is eligible for this program? Be at least age 60. Be the widow or widower of a fully insured worker. Meet the marriage duration requirement. Be unmarried, unless the marriage can be disregarded. Not be entitled to an equal or higher Social Security retirement benefit based on your own work.
You can apply for benefits by calling our national toll-free service at 1-800-772-1213 (TTY 1-800-325-0778) or visiting your local Social Security office. An appointment is not required, but if you call ahead and schedule one, it may reduce the time you spend waiting to apply.

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People also ask

Benefits For Your Divorced Spouse If you are divorced, your ex-spouse can receive benefits based on your record (even if you have remarried) if: Your marriage lasted 10 years or longer. Your ex-spouse is unmarried. Your ex-spouse is age 62 or older.
Any person with a previous marriage that ended in divorce is eligible if the ex-spouse was fully insured for Social Security benefits and the marriage lasted at least 10 years. A person with a previous marriage that ended in widowhood is also eligible if the spouse was fully insured.
Form SSA-2 | Information You Need to Apply for Spouses or Divorced Spouses Benefits. You can apply: Online, if you are within 3 months of age 62 or older, or. By calling our national toll-free service at 1-800-772-1213 (TTY 1-800-325-0778) or visiting your local Social Security office.
Benefits For Your Divorced Spouse If you are divorced, your ex-spouse can receive benefits based on your record (even if you have remarried) if: Your marriage lasted 10 years or longer. Your ex-spouse is unmarried. Your ex-spouse is age 62 or older.
A spousal benefit is reduced 25/36 of one percent for each month before normal retirement age, up to 36 months. If the number of months exceeds 36, then the benefit is further reduced 5/12 of one percent per month.

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842, 730, 624943, CRYOSTAR NX50 HV LOW PROFILE, 09/04/2019, PO# 730-43565, H0104 962, 730, 613195, ROLAND MULTI-FORMAT SWITCHER, 01/22/2014, Z6D0936

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Certificate of Election for Reduced Widow(er)s and Surviving

Form SSA-4111 (04-2019) UF. Discontinue Prior Editions. Social Security Administration. CERTIFICATE OF ELECTION FOR REDUCED WIDOW(ER)S AND.

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