Form SSA-1-BK Application for Retirement Insurance Benefits

Form SSA-1-BK Instructions

Follow these steps to fill out the Retirement Insurance Benefits Form:

1. If you have already completed Form SSA-2-BK, Application for Wife's or Husband's Insurance Benefits, only complete the circled items;
2. State your full name, gender, and social security number (SSN). Record other names or SSNs you had;
3. Specify the language you prefer if English is not your preferred language;
4. Enter your date and place of birth, and indicate whether there were public and religious records of your birth made before you were 5. State whether you are a U.S. citizen or lawfully present alien, and when were you lawfully admitted to the U.S.;
5. Answer "yes" by ticking the appropriate boxes if you have been unable to work during the past 14 months due to illness or injury, filed an application for Social Security, Supplemental Security Income, or Medicare insurance, have been in the active military or naval service between 1939 and 1968, or have been eligible for benefits from a military or civilian agency;
6. State whether you or your spouse worked in the railroad industry or have Social Security credits in another country;
7. If you were born in 1924 and later, indicate whether you are entitled to an annuity or pension based on your work after 1956;
8. Provide information about your current marriage and other marriages that lasted at least 10 years or ended due to the death of your spouse. Enter the spouse's name, date of birth and death, social security number, date and place of marriage, how, when, and where the marriage ended;
9. Name all your children or dependent grandchildren under age 18 or disabled;
10. Provide your employment information and state your total earnings last year and expected earnings this and next year;
11. Answer when do you want to receive benefits. If you want to, enroll in Medicare Part B or file for Supplemental Security Income;
12. Sign and date the form. Add your account information to receive a direct deposit from the SSA.

Not the form you were looking for? Check out these related documents:

• Form SSA-16, Application for Disability Insurance Benefits;
• Form SSA-8000-BK, Application for Supplemental Security Income;
• Form SSA-8, Application for Lump-Sum Death Payment;
• Form SSA-24, Application for Survivors Benefits.