Download Form SSA-10 Application for Widow's or Widower's Insurance Benefits
Form SSA-10 Instructions
The general instructions for completing the SSA Form 10 are provided in the form. Find the detailed step-by-step filling out instructions below. Complete only the circled items if you were receiving the spouse's benefits at the time of your spouse's death. Otherwise, fill out the entire form.
Fill out the form as follows:
- Item 1 and 2 are self-explanatory;
- Part I. Information about the Deceased. Enter detailed information about your deceased spouse, including dates of birth and death, place of death, place of permanent residence, applications for Social Security benefits, ability to work, active military or naval services (if applicable), and income;
- Information about the Deceased's Marriages. Fill out this part only if the deceased spouse had any other marriages;
- Item 12A. Complete it if the deceased spouse married someone after the marriage to you. If this is the case, provide the details on the last marriage;
- Item 12B. Complete it to provide details on any other marriage that lasted 10 years minimum or ended because of the death of the spouse. If you need more space, use the "Remarks" section;
- Item 13. Specify if there are surviving parents who were receiving support from your deceased spouse at the time of death. If yes, specify the address in the "Remarks" section;
- Part II. Information about Yourself. Most items of this part are self-explanatory. They require information about the place you were born, record of your birth, information about all of your marriages (including marriage to the deceased, your previous and subsequent marriages), information whether you lived with the deceased at the time of death, your applications for Social Security benefits, your ability to work, and other details;
- Item 23. If you are within 3 months of 65 years old or older, you may choose to enroll in the Medical Insurance;
- Items 24 - 27. Provide details about your earnings;
- Item 28. Complete it only if you are not of full retirement age yet;
- Item 29. If you are at least 61 years and 8 months, you may choose this application to be considered as an application for retirement benefits on your own record;
- Remarks. Enter here any additional explanations or information;
- Specify the details of your direct deposit payment address;
- Sign the document, indicate the date, phone number, and full mailing address.
Where to Mail Form SSA-10?
Mail the completed Form SSA-10 to your local Social Security office. Find the address of the nearest office on the SSA website or by calling the national toll-free number provided on page 4 of the form.