Social Security Administration Payments Item Veteran Spouse, if applicable Is the veteran or spouse eligible to (Check one) one) □Yes □No □Yes □No receive Social Security benefits? Is the veteran or spouse receiving one) (Check one) □Yes □No □Yes □No Social Security benefits? If yes, how much is being received $_________ $_________ month each month? ($/month)? Should the survivor switch to (Check one) (Check one) □Yes □No □Yes □No spouse’s higher amount? Retirement Benefits for Other Government Organizations or local government organizations or agencies Item Veteran Spouse, if applicable Is the veteran or spouse receiving (Check one) (Check one) □Yes □No □Yes □No retirement pay or benefits from any such organizations? If yes, how much is being received $_________ month $_________ month each month? ($/month)? Is the Survivor eligible for survivor (Check one) one) □Yes □No □Yes □No benefits from these organizations?
Social Security Administration Payments Item Veteran Spouse, if applicable Is the veteran or spouse eligible to receive Social Security benefits? □Yes □No (Check one) □Yes □No one) Is the veteran or spouse receiving Social Security benefits? □Yes □No one) □Yes □No (Check one) If yes, how much is being received each month? ($/month)? $_________ $_________ month Should the survivor switch to spouse’s higher amount? □Yes □No (Check one) □Yes □No (Check one) Retirement Benefits for Other Government Organizations or local government organizations or agencies Item Veteran Spouse, if applicable Is the veteran or spouse receiving retirement pay or benefits from any such organizations? □Yes □No (Check one) □Yes □No (Check one) If yes, how much is being received each month? ($/month)? $_________ month $_________ month Is the Survivor eligible for survivor benefits from these organizations? □Yes □No (Check one) □Yes □No one)
DAV%20SAG%20JUNE%202015.docx