SSA-788 (current)

SOCIAL SECURITY ADMINISTRATION

Form Approved
OMB No. 0960-0398

TOE 210

(Do not write in this space)

CERTIFICATE OF ELECTION FOR
REDUCED SPOUSE'S BENEFITS

ENTER HIS OR HER SOCIAL SECURITY NUMBER

1. PRINT NAME OF WAGE EARNER OR SELF-EMPLOYED PERSON
(Hereafter called "Worker")

2. PRINT YOUR FULL NAME (First name, middle initial, last name)

ENTER YOUR SOCIAL SECURITY NUMBER

(If "none" or "unknown" so indicate.)

A spouse's insurance benefit may be payable for months between age 62 and full retirement age (FRA), even if you
do not have in your care a child of the worker under age 16 or disabled entitled to a child's insurance benefit.
Choosing to receive spouse's insurance benefits before FRA will result in a permanent reduction in your monthly
benefits. Since such benefit will be at a permanently reduced rate and will continue at a permanently reduced rate
even after FRA, the law requires that we obtain a certificate of election if you wish to receive the permanently
reduced benefit. The amount of the reduction is 25/36 of 1 percent for each of the first 36 months from the start of
the permanently reduced benefits to, but not including, the month you reach FRA. The reduction is 5/12 of 1 percent
for each such month in excess of 36. In addition, if another beneficiary(ies) other than the wage earner (e.g., a
student child beneficiary) is entitled to a monthly benefit on this Social Security number, election for a reduced
spouse's benefit may cause a reduction in total monthly benefits. These reduced benefits may be paid for as many as
12 months before the month this certificate is filed. No reduced spouse's benefit may begin before the month you are
62. If you are eligible for retirement insurance benefits in the month this certificate takes effect, you will be
considered to have applied for them.
3. I elect to accept permanently reduced benefits as provided
in Section 202(q) of the Social Security Act, beginning with

(Month)

(Year)

4. Did you work in the railroad industry for 5 years or more?
Yes

No

I declare under penalty of perjury that I have examined all the information on this form, and on any
accompanying statements or forms, and it is true and correct to the best of my knowledge.
SIGNATURE OF PERSON COMPLETING THIS CERTIFICATE
Date (Month, day, year)

Signature (First name, middle initial, last name) (Write in ink)

SIGN
HERE

u

Telephone Number (include area code)

Mailing Address (Number and Street, Apt. No., P.O. Box, or Rural Route)
City and State

ZIP Code

Enter Name of County (if any) in which you now live

Witnesses are required ONLY if this certificate has been signed by mark (X) above. If signed by mark (X), two
witnesses to the signing who know the person completing this certificate must sign below, giving their full addresses.
1. Signature of Witness

2. Signature of Witness

Address (Number and Street, City, State and ZIP Code)

Address (Number and Street, City, State and ZIP Code)

Form SSA-25 (01-2010) EF (01-2010) Destroy Prior Editions

Privacy Act Statement
Collection and Use of Personal Information
Section 202q(5)(A) of the Social Security Act (42 U.S.C. 402q(5)(A)), as amended, authorizes us to collect this
information. The information you provide will be used to determine whether you may be eligible to receive
reduced benefits as a spouse.
The information you furnish on this form is voluntary. However, failure to provide the requested information may
prevent us from making a determination regarding payment of reduced benefits.
We rarely use the information you supply for any purpose other than for making a determination relating to
approval for reduced benefits. However, we may use it for the administration and integrity of Social Security
programs. We may also disclose information to another person or to another agency in accordance with approved
routine uses, which include but are not limited to the following:
1.

To enable a third party or an agency to assist Social Security in establishing rights to Social Security
benefits and/or coverage;

2.

To comply with Federal laws requiring the release of information from Social Security records (e.g.,
to the Government Accountability Office and Department of Veterans' Affairs);

3.

To make determinations for eligibility in similar health and income maintenance programs at the
Federal, state, and local level; and

4.

To facilitate statistical research and audit activities necessary to assure the integrity and improvement
of Social Security programs (e.g., to the Bureau of the Census and private concerns under contract to
Social Security).

We may also use the information you provide in computer matching programs. Matching programs compare our
records with records kept by other Federal, state, or local government agencies. Information from these matching
programs can be used to establish or verify a person's eligibility for Federally funded or administered benefit
programs and for repayment of payments or delinquent debts under these programs.
Additional information regarding this form, routine uses of information, and our programs and systems, is
available on-line at www.socialsecurity.gov or at your local Social Security office.

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507,
as amended by Section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions
unless we display a valid Office of Management and Budget control number. We estimate that it will take about 2
minutes to read the instructions, gather the facts, and answer the questions. SEND OR BRING THE
COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. The office is listed under U. S.
Government agencies in your telephone directory or you may call Social Security at 1-800-772-1213 (TTY
1-800-325-0778). You may send comments on our time estimate above to: SSA, 6401 Security Blvd., Baltimore,
MD 21235-6401. Send only comments relating to our time estimate to this address, not the completed form.

Form SSA-25 (01-2010) EF (01-2010)