Social Security Questionnaire

1. Personal/Contact Information:

Your Name (required):
Date of Birth:
Preferred Phone Number:
Your Email (required):
Spouse Name:
Spouse Date of Birth:

2. If you or your spouse is still working, please provide the requested information:

“Stop working date” means the date after which you do not expect to report any earnings from employment.

You:
Spouse:

3. Expected Social Security earnings each year until "stop working" date:

“Earnings” means income received from employment; it does not include items like investment income, pensions, annuities, royalties, gifts, or inheritances.

You:

Spouse:

4. If you are currently married, when (date) did you get married?

5. If your marital situation is likely to change in the foreseeable future? If yes, please explain:

It would be important for me to know if you expect to get divorced; or if you are contemplating marriage; or if you or your spouse is faced with a life-threatening health situation.

6. If either you or your spouse is not a United States citizen, please explain here:
You:
Spouse:

7. Former marriages: If either you or your spouse were married previously, please provide a brief explanation including the number of years married and whether the marriage ended by divorce or death.

8. If you have any minor children living at home please provide the requested information:
Name:
Date of Birth:
Date of H.S. Graduation

Name:
Date of Birth:
Date of H.S. Graduation

9. If you have any Disabled Adult Children (disabled before age 22) in your care please explain:

10. If you or your spouse currently receives Social Security benefits please provide the requested information. Your responses are critical and must be accurate.

You:
Spouse:

Type of benefits: DisabilitySpousalSurvivorRetirement

Current Monthly Benefits:

Date benefits began:

Please indicate the gross benefits, before deductions for Medicare premiums or withholding. Benefits are paid in arrears, and thus generally “began” the month before you received your first payment.

11. If either you or your spouse receive or expect to receive, a pension based on earnings on which Social Security taxes were not paid, please indicate:

Name of pension recipient
Amount of pension per month
Date pension payments began (or will begin)

12. Please prioritize the following items 1 through 4 in order of their importance to you, where 1 is most important and 4 is least important. If any item is of little to no interest to you, you may assign it a 0 or leave it out of the ranking.

Maximize the total combined benefits you would receive from the Social Security system over your assumed life expectancies (also referred to as total lifetime benefits)

Maximize the combined monthly benefits you will receive at older ages (70’s and 80's)

Maximize benefits that the survivor of you will receive after one of you passes away

Maximize early benefits: start early with focus on younger ages (60’s)

Other (please specify):

13. If there is a claiming strategy that you are inclined to implement or would like to see illustrated, please describe by indicating when you and your spouse would each plan to claim benefits.

You:
Spouse:

14. Normally I use the following life expectancy assumptions: Husband – 90 Wife – 95. The idea is not to predict how long you will live, but to think about how long one or both of you might live. How long is your planning horizon? To what extent do you want to protect against the risk of running short of money if even one of you lives a long life. If you want me to use different assumptions, please provide those here:

You:
Spouse:

For an average male/female couple each of whom is currently age 65, actuarial tables say there is a 50% probability of at least one spouse living to age 92.

15. If either you or your spouse contributes to a Health Savings Account (HSA), please indicate who is making the contributions and the date on which you expect those contributions to terminate.

You:

Spouse:

16. Please upload XML and PDF files containing your complete Social Security Earnings Records for you and your spouse. These files may be downloaded from your “my Social Security” accounts.

You:


Spouse:

Need help with this questionnaire? Call Peter at 802-229-0940