, Sr., etc.) — — — APPLICANT’S SOCIAL SECURITY NUMBER APPLICANT’S DATE OF BIRTH (MM-DD-YYYY) 2. If you are married and living with your spouse, please provide the following information as it appears on your spouse’s Social Security card. If you are not currently married, do not live with your spouse or are widowed, skip to question 3 and do not include any information about your spouse on this application. FIRST NAME MI SUFFIX (Jr., Sr., etc.) LAST NAME — — SPOUSE’S SOC.
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How to fill out the SSA-1020B-OCR-SM-INST online
The SSA-1020B-OCR-SM-INST form is essential for applying for Extra Help with Medicare Prescription Drug Plan costs. This guide provides a straightforward, step-by-step approach to ensure users can confidently complete the form online.
Follow the steps to fill out the SSA-1020B-OCR-SM-INST effectively.
- Click the ‘Get Form’ button to access the SSA-1020B-OCR-SM-INST, allowing you to open and review the form in the online editor.
- Begin filling out Section 1 with the applicant's name as it appears on the Social Security card. Ensure you use capital letters and keep your entries within the designated boxes.
- If applicable, provide your spouse's name and Social Security number in Section 2. If you are not currently married, proceed to question 3.
- In question 3, indicate whether the value of your combined savings and investments exceeds the given limits, noting exceptions for certain properties.
- Continue to answer questions regarding your assets, income, and any support you provide to relatives living with you in sections 4 through 8.
- For questions 9 to 14, provide information about your employment and any relevant income details, ensuring accuracy for the figures reported.
- Review question 15 regarding your interest in Medicare Savings Programs. If you wish to be considered for this program, do not complete this question.
- Regardless of assistance, fill out Section A to provide your date and signature along with any necessary details about your mailing address.
- If someone assisted you in completing the form, ensure to fill in Section B, providing their details as necessary.
- After reviewing all your answers for accuracy, save your changes, and then proceed to download, print, or share the form as required.
Complete the SSA-1020B-OCR-SM-INST online today to apply for Extra Help with your Medicare expenses.
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