Questionnaire

Thank you! Your payment has been successfully submitted.Please note the charge for your benefit planning service will show as Sykes Document Services on your credit card or bank statement.

For us to properly customize your strategy and reports, we ask that you fill in the questions as accurately as possible. Items marked with * are required information. The more complete the information, the quicker the process and the sooner we are able to help you discover your maximum Social Security benefits!

Please take a moment and retrieve your current statement at www.ssa.gov if you have not already done so. Additionally, if you have a pension and did NOT pay into Social Security during that time, please have this information available as well to attach.

If currently married, your spouse will also need to complete a form as well. Click here to provide them a link to the Spousal Information form.

Important: Do not include your Social Security number as we do not need this personal information for analysis.

1Personal Info/Family History

2Retirement and Pension

3Marital Status

4Additional Information

Personal Information
Full Legal Name*
Has your spouse already completed this form?
- Yes
- No (If not please forward this link) https://ssbp.mystagingwebsite.com/questionnaire
Account ID

If you know your account number, please enter it here.
Email*
Phone Number*
Mobile Phone
Birth Date*
MM slash DD slash YYYY
Gender*
Country of Origin*
Personal Health*
Life Expectancy Age
FAMILY HISTORY
Mother's Date of Birth
MM slash DD slash YYYY
Mother's Status
- Living
- Deceased
Mother's Health*
Mother's Date of Death (if applicable)
MM slash DD slash YYYY
Mother's Cause of Death (if applicable)
Father's Date of Birth
MM slash DD slash YYYY
Father's Status
- Living
- Deceased
Father's Health*
Father's Date of Death (if applicable)
MM slash DD slash YYYY
Father's Cause of Death (if applicable)

RETIREMENT AND PENSION INFORMATION
Desired retirement start date or date of your first Social Security check:*
DD slash MM slash YYYY
Full Retirement Age (FRA) Monthly Amount:

Estimated amount you are expecting to receive if you retire at your FRA.
Please attach most recent Social Security Statement from www.ssa.gov (Please attach both if married)*
Drop files here or

Accepted file types: pdf, jpg, png, xls, xlsx, xlm, Max. file size: 2 GB, Max. files: 5.
Required pdf, jpg, png, xls, xlsx, xlm
Please attach an up-to-date Non-Covered Pension statement if applicable (Non-covered is when your employer did not pay into Social Security during working years that apply to the pension.) Applies to some teachers, federal employees, police and firefighers.
Accepted file types: pdf, jpg, png, xls, xlsx, xlm, Max. file size: 2 GB.
Monthly Amount of your Projected Pension
Date you plan to start your pension
MM slash DD slash YYYY
*Do you qualify for a non-covered pension from a spouse?*
If Yes, please enter non-covered pension amount
Please attach any non-covered pension documents if applicable
Accepted file types: pdf, jpg, png, xls, xlsx, xlm, Max. file size: 2 GB.
Total Retirement assets value*
Estimated annual household earnings 2022*
Estimated annual household earnings 2023 and later*
Estimated Tax Rate %*

To look up your 2022 tax rate, click here
Are you currently on Social Security Disability?*
Current Social Security Benefit
Are you an immigrant to the U.S.?*
If "No" please type "N/A" as the answer to the next question.
Country of Origin*
Do you plan on retiring out of the U.S. permanently?*
If so, which country?

Full Name	Gender	Birthday xx/xx/xxxx	Date of Marriage	Date of Divorce	Date of Passing	Cause of Death	Their SS Benefit If known

Personal Information

FAMILY HISTORY

RETIREMENT AND PENSION INFORMATION

MARITAL STATUS

MINOR CHILDREN INFORMATION

ADDITIONAL INFORMATION

Name	Date of Birth	Income	On Disability Currently?