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Form 668-B online Fort Wayne Indiana: What You Should Know

Gov/s/index.htm Applying for Social Security or Medicare: The U.S. Government assumes legal responsibility for your payments under the Social Security Act and Medicare Act. All applications filed under these programs are subject to collection under section 5121 of the Internal Revenue Code. For Social Security, a Form SS-5 is used in lieu of Form SS-5A. For Medicare, a Form 1095-A or Form 1096-A (PDF, 4.5 MB) will be used. The Form SS-5 is found in Appendix A to this publication. Forms 1095‑SSA, 1095‑SA‑1, 1095‑SA‑2, 1095‑SA‑3, 1095‑SA‑4, 1095‑SA‑5, 1095‑SA‑6, 1095‑SA‑9, 1095‑SSA‑10 (PDF, 13.5 MB), 1095‑SSA‑10A (PDF, 13.8 MB), 1094‑SSA (PDF, 4.3 MB), 1094‑SR (PDF, 5.1 MB) and 1094-SSN (PDF, 2.9 MB) are used to report your earnings as they come into or leave the United States. Application Process (PDF, 704 KB) To download the application forms, click here To view more information on Medicare and Social Security, select this link: Applying by Mail/Phone: You may still apply online at MAP.gov. Please refer to Section 2550(f)(1)(B) for more details. Applying by Mail — U.S. Mail — MAP:Mail Address: U.S. Postal Service — MAP:Mail Address: Address changes or updates have been made to these locations. MAP cannot be responsible for any errors or omissions that occur, or for any changes that may have occurred. The information you provide is confidential The information you provide is confidential We will make every effort to ensure the information we obtain is accurate. However, MAP is unable to guarantee accuracy. MAP will not be responsible for any mistakes, fraud, inadvertent omissions, or omissions that occur. We provide you with access to this information so that you can complete the application. But, if you select the “complete application” button, your application will no longer appear on MAP.

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