Get IA DoR 54-130 2015
E, first name Birthdate (MMDDYYYY): SSN: Current mailing address (Include Apt, Lot, or Suite): City: State: ZIP: WHO IS ELIGIBLE: 1. Were you (or your spouse) born before 1951? ....................................................... Yes 2. Were you (or your spouse) born between 1951 and 1997 and totally disabled? .... Yes No No Proof of disability must be included with your claim. Include a copy of letter from Social Security Administration, Veterans Administration, your doctor, or Form SSA-.
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