SOCIAL SECURITY ADMINISTRATION TEL Form Approved OMB No* 0960-0618 TOE 120/145/155 Do not write in this space APPLICATION FOR RETIREMENT INSURANCE BENEFITS I apply for all insurance benefits for which I am eligible under Title II Federal Old-Age Survivors and Disability Insurance and Part A of Title XVIII Health Insurance for the Aged and Disabled of the Social Security Act as presently amended* Supplement. If you have already completed an application entitled you need complete only the circled ...
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