Loading
Form preview picture

Get SSA FSMSS-118 2012

FSM Social Security Administration P. O. Box L Kolonia Pohnpei FM 96941 Tel. No. 691 320-2708 Fax No. 691 320-2607 E-Mail fsmssa mail.fm FSMSS-118 Sept. Have you remarried yes no 3. Do you have children receiving social security benefits 4. Are any of the children receiving social security benefits married working adopted no longer live with you yes no name of child ss number died Wage Earner s Name IMPORTANT n This survey form must be notarized if not signed in the presence of a representative of the FSMSSA. n If you are living abroad and employed please submit along with this survey form copies of W-2 forms for all years you have been employed. BENEFICIARY S DECLARATION I understand that any false statement or misrepresentation of any fact in maintaining a right for benefits is a crime punishable under Title 53 of the FSM Code. 2012 QUESTIONNAIRE Dear Beneficiary Please complete this survey and submit it to our office as soon as possible. Failure to do so will result in benefit withholding. Thank you. Retirement Disability 1. Are you working now 1. Are you working now yes no If yes since when Date 2. Has your condition improved This section for all* Do not leave blank. Retiree disablility recipient or surviving spouse died Who died print name ss when Surviving Spouse or Guardian skip to item 4 2. Have you remarried yes no 3. Do you have children receiving social security benefits 4. Are any of the children receiving social security benefits married working adopted no longer live with you yes no name of child ss number died Wage Earner s Name IMPORTANT n This survey form must be notarized if not signed in the presence of a representative of the FSMSSA. n If you are living abroad and employed please submit along with this survey form copies of W-2 forms for all years you have been employed* BENEFICIARY S DECLARATION I understand that any false statement or misrepresentation of any fact in maintaining a right for benefits is a crime punishable under Title 53 of the FSM Code. Beneficiary s Printed Name Signature Authorized Representative Relationship to Beneficiary attach authorization slip Beneficiary Current Address How long have you been at this address Telephone No* Cell Phone No* Municipality Interviewer. 2012 QUESTIONNAIRE Dear Beneficiary Please complete this survey and submit it to our office as soon as possible. Failure to do so will result in benefit withholding. Thank you. Retirement Disability 1. Are you working now 1. Failure to do so will result in benefit withholding. Thank you. Retirement Disability 1. Are you working now 1. Are you working now yes no If yes since when Date 2. Has your condition improved This section for all* Do not leave blank. Are you working now yes no If yes since when Date 2. Has your condition improved This section for all* Do not leave blank. Retiree disablility recipient or surviving spouse died Who died print name ss when Surviving Spouse or Guardian skip to item 4 2. Retiree disablility recipient or surviving spouse died Who died print name ss when Surviving Spouse or Guardian skip to item 4 2. Have you remarried yes no 3. Do you have children receiving social security benefits 4. Are any of the children receiving social security benefits married working adopted no longer live with you yes no name of child ss number died Wage Earner s Name IMPORTANT n This survey form must be notarized if not signed in the presence of a representative of the FSMSSA. .

How It Works

Pohnpei rating
4.9Satisfied
375 votes

How to fill out and sign Disablility online?

Get your online template and fill it in using progressive features. Enjoy smart fillable fields and interactivity. Follow the simple instructions below:

Tax, legal, business as well as other e-documents demand a top level of protection and compliance with the law. Our templates are updated on a regular basis in accordance with the latest amendments in legislation. In addition, with us, all of the information you include in the SSA FSMSS-118 is well-protected against leakage or damage with the help of industry-leading encryption.

The following tips will help you fill in SSA FSMSS-118 easily and quickly:

  1. Open the template in our full-fledged online editing tool by clicking Get form.
  2. Complete the required fields which are marked in yellow.
  3. Press the green arrow with the inscription Next to jump from box to box.
  4. Use the e-autograph tool to e-sign the form.
  5. Add the relevant date.
  6. Double-check the whole document to make sure you haven?t skipped anything.
  7. Press Done and save the new document.

Our service allows you to take the whole procedure of executing legal papers online. For that reason, you save hours (if not days or weeks) and eliminate additional costs. From now on, complete SSA FSMSS-118 from the comfort of your home, office, as well as while on the move.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.

Video instructions and help with filling out and completing FSMSSA

Are you exhausted from extended recommendations and puzzling inquiries in formal papers? Utilizing our simple video tutorial and web-based editor will help you complete and sign Form without the usual frustration.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.

Ensure the security of your data and transactions

USLegal fulfills industry-leading security and compliance standards.

  • VeriSign logo picture

    VeriSign secured

    #1 Internet-trusted security seal. Ensures that a website is free of malware attacks.

  • Norton logo picture

    Norton Secured

    The highest level of recognition among eCommerce customers.

  • Accredited Business

    Guarantees that a business meets BBB accreditation standards in the US and Canada.

  • TopTenReviews logo picture

    TopTen Reviews

    Highest customer reviews on one of the most highly-trusted product review platforms.