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 was released by the U.S. Social Security Administration (SSA) on October 1, 2019, with previous editions obsolete. An SSA-10 fillable form is available for download and digital filing below.
The document has two related forms, Form SSA-10-INST, Reporting Responsibilities for Widow's or Widower's Insurance Benefits, used to inform recipients of widow's or widower's insurance benefits about their reporting responsibilities, and Form SSA-4111, Certification of Election for Reduced Widow(er)'s and Surviving Divorced Spouse's Benefits, is a form you need to complete if you want to receive a reduced widow's, widower's, or surviving divorced spouse's benefits.
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