Form SSA-10, Application for Widow's or Widower's Insurance Benefits is a form used by the surviving spouse of an insured wage earner to claim for insurance benefits on the wage earner's file. Use this form to request all insurance benefits you may be eligible for according to Title II: Federal Old-Age, Survivors, and Disability Insurance and Title XVIII, Part A: Health Insurance for the Aged and Disabled.
Form SSA-10 - also known as the SSA Form 10 - was issued by the Social Security Administration (SSA). The latest version of the form was released on October 1, 2019, with previous editions obsolete and an SSA-10 fillable form available for download and digital filing below.
The document has two related forms: