SSA-4111(current)
SSA-4111 - Current Non-Fillable.pdf
Certificate of Election for Reduced Widow(er)’s and Surviving Divorced Spouse’s Benefits
SSA-4111(current)
OMB: 0960-0759
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0960-0759 can be found here:
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| File Type | application/pdf |
| File Title | P352B82-20151016141157 |
| File Modified | 2016-01-19 |
| File Created | 2015-10-16 |