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Form approved noomb 0960 0051-2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the Worker’s Social Security Number and the full name of the worker on whose earnings this claim is based. Ensure accuracy as this information is crucial for processing.
- In section 3, list the names of each beneficiary in the same household who is, was, or will be outside the United States. Include their country of birth and current residence.
- For item 4, if any beneficiary has been outside the U.S. recently or will be in the next 18 months, provide their names and relevant dates.
- Proceed to items 6 through 14 to answer questions regarding employment status and residency. Be thorough in your responses to avoid delays.
- Complete your payment address in item 15 and mailing address in item 16 if they differ from your residence address.
- Finally, ensure all listed individuals sign where indicated in item 18, confirming that all information provided is accurate.
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