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Get Checklist For Online Medicare Retirement And Spouses Applications

Social Security Administration Checklist For Online Medicare Retirement and Spouses Applications This checklist will help you gather the information you may need to complete the online Medicare Retirement and Spouse s applications. We recommend you print this page to use while you gather your information* We hope you find our online application easy and convenient. Medicare Only Retirement and/or Spouses If you were born outside the United States or its territories Name of your birth country at the time of your birth it may have a different name now Permanent Resident Card number if you are not a U. S citizen X Medicaid state health insurance Number Start and End Dates Information Date and Place of Birth Current Health Insurance Employment start and end dates for the current employer of you or your spouse who provides your health insurance coverage through a Group Health Plan Start and end dates for the Group Health Insurance provided by you or your spouse s current employer Marriage and Divorce Name of current spouse Name of prior spouse if the marriage lasted more than 10 years or ended in death Spouse s date of birth and SSN optional Beginning and ending dates of marriage s Place of marriage s city state or country if married outside the U*S* Names and Dates of Birth of Children Who Became disabled prior to age 22 or Are under age 18 and are unmarried or Are aged 18 to 19 and still attending secondary school full time U*S* Military Service Type of duty and branch Service period dates Employer Details for Current Year and Prior 2 Years not self-employment View your Social Security Statement online at http //www. socialsecurity. gov/myaccount/ Employer name Self-Employment Details for Current Year and Prior 2 Years Business type Total net income Direct Deposit Domestic bank USA Account type and number Bank routing number International bank non-USA Bank name bank code and currency Branch/transit number We may contact you for additional information after you submit your online application*. We recommend you print this page to use while you gather your information* We hope you find our online application easy and convenient. Medicare Only Retirement and/or Spouses If you were born outside the United States or its territories Name of your birth country at the time of your birth it may have a different name now Permanent Resident Card number if you are not a U. Medicare Only Retirement and/or Spouses If you were born outside the United States or its territories Name of your birth country at the time of your birth it may have a different name now Permanent Resident Card number if you are not a U. S citizen X Medicaid state health insurance Number Start and End Dates Information Date and Place of Birth Current Health Insurance Employment start and end dates for the current employer of you or your spouse who provides your health insurance coverage through a Group Health Plan Start and end dates for the Group Health Insurance provided by you or your spouse s current employer Marriage and Divorce Name of current spouse Name of prior spouse if the marriage lasted more than 10 years or ended in death Spouse s date of birth and SSN optional Beginning and ending dates of marriage s Place of marriage s city state or country if married outside the U*S* Names and Dates of Birth of Children Who Became disabled prior to age 22 or Are under age 18 and are unmarried or Are aged 18 to 19 and still attending secondary school full time U*S* Military Service Type of duty and branch Service period dates Employer Details for Current Year and Prior 2 Years not self-employment View your Social Security Statement online at http //www.

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