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1. Signature of Witness Address Number and street City State and ZIP Code Form SSA-4111 12-2013 EF 12-2013 Destroy Prior Editions over Privacy Act Statement Collection and Use of Personal Information Sections 202 e f and q 3 of the Social Security Act as amended authorize us to collect this information. We will use the information you provide to determine your eligibility for reduced benefits as a widow er or a surviving divorced spouse. Form Approved OMB No* 0960-0759 Social Security Administration CERTIFICATE OF ELECTION FOR REDUCED WIDOW ER S AND SURVIVING DIVORCED SPOUSE S BENEFITS 1. Print Name of Wage Earner or Self-Employed Person Hereafter called Worker Enter His or Her Social Security Number 2. Print Your Full Name First name middle initial last name Enter Your Social Security Number If none or unknown so indicate. INFORMATION ABOUT REDUCED WIDOW ER S AND The law requires that you complete and return this Certificate of Election if you wish to receive a reduced widow s widower....

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Related content

Certificate of Election for Reduced Widow(er)'s...
Form SSA-4111 (04-2019) UF. Discontinue Prior Editions. Social Security Administration...
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's And Surviving Divorced Spouse's Benefits 4111...
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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
SSA-4111
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