Form Ssa-2000-F6 - Application For Special Benefits For World War Ii Veterans

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FORM APPROVED
SOCIAL SECURITY ADMINISTRATION
OMB NO. 0960-0615
APPLICATION FOR SPECIAL BENEFITS FOR WORLD WAR II VETERANS
FILING DATE
Month, Day, Year
I am applying for all benefits for which I am eligible under title VIII
(Special Benefits for Certain World War II Veterans) of the Social
Security Act, and for benefits under other programs administered by
Actual
the Social Security Administration.
or
Protective
1. (a) Print your name (First Name, Middle Initial, Last Name)
(b) Enter your date of birth
Month, Day, Year
2. (a) Enter your Social Security Number
(b) Did you ever use any other names (including maiden name) or other Social
YES
NO
Security Numbers (SSN)?
(c) Other Names or SSNs Used
3.
Sex
male
female
4. (a) Have you (or has someone on your behalf) ever filed an application for
YES
NO
Supplemental Security Income (SSI)?
(b) Are you currently receiving SSI payments?
YES
NO
If “NO,” when did you last receive SSI payments?
Month
Year
5. (a) Were you in the active military, naval or air service of the United States after
YES
NO
September 15, 1940 and before July 25, 1947?
From: (Month, Year)
To: (Month, Year)
(b) Enter dates of service.
6. (a) Were you in the organized military forces of the Government of the Commonwealth
of the Philippines, while the forces were in the service of the Armed Forces of the
United States pursuant to the military order of the President dated July 26, 1941?
This includes organized guerrilla forces under commanders appointed, designated,
YES
NO
or subsequently recognized by the Commander in Chief, Southwest Pacific Area, or
other competent authority in the Army of the United States. You must have been in
this service after July 25,1941 and before December 31,1946.
From: (Month, Year)
To: (Month, Year)
(b) Enter dates of service.
IF YOU ANSWER “NO” TO ITEMS 5 AND 6, GO ON TO SIGNATURE BLOCK ON PAGE 4.
Form SSA-2000-F6 (09-2016)
Page 1
Destroy Prior Editions

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