Tips for completing the application for extra help
Here are some tips to help you complete the application. Following these tips will help us process your application as quickly as possible.
Computers read your application when you send it back to Social Security. Use only a pen with black ink to complete the application. The computer cannot read ink of any color other than black and this could cause a delay in getting you an answer about your application for Extra Help.
Many questions on the application ask you to mark an “X” in a “Yes” or “No” box. Please remember that you cannot mark an “X” in both the “Yes” and “No” boxes.
Your Social Security number or Railroad Retirement Board number must be included on the application. In order to receive a quick response from us, please be sure you enter your name and number exactly as they appear on your Social Security card or Railroad Retirement Board card.
If you are single, widowed, divorced or not living with your spouse, do not complete question 2 (marital information), and do not write in any boxes anywhere on the form that ask for information about your spouse.
When you file your application for Extra Help, you also can start your application process for the Medicare Savings Programs — State programs that provide help with other Medicare costs. Social Security will send information to your State unless you tell us not to on the Extra Help application. Your State will contact you to help you apply for a Medicare Savings Program. Do not complete question 15 if you want help from the Medicare Savings Programs.
Please send the entire application package back to us — not just the page that you signed. If you are unable to answer all the questions, send your application and we will help you complete it.
There is no need to send us anything other than your completed application. We do not need to see doctor bills, prescription lists, Internal Revenue Service (IRS) forms or other documents.
Apply online at www.socialsecurity.gov or complete an original paper application. Please do not complete a photocopied, faxed or downloaded copy of the application. Anything other than the online or original paper application could cause a delay in getting you an answer about your application for extra help. If you need a paper application, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) or visit a Social Security office and ask for an application for extra help. Social Security representatives are available to help you complete your application.
If relatives, neighbors or friends want an application, have them visit Social Security online or call us to ask for an application. Please do not share your application with them.