Important: This is an independent document preparation service and is not affiliated with Medicare or the Social Security Administration.

See what you get before you pay

We offer a redacted sample of a prepared packet. You will see the SSA 44 form with key fields labeled. You will see the one page filing guide. You will see the document checklist.

Nothing hidden. Nothing confusing.

Sample packet—not for filing

This example is produced by the actual packet generator using fictional data. Identifying fields are replaced; no customer data is published. Income and event details are illustrative, not advice for your situation.

Open the full sample PDF (9 pages) →Download the sample packetSample SSA-44 page; fictional information, not for filing

Filing guide and event-specific evidence checklist

Sample filing guide with supporting evidence checklist and submission instructions

You must verify all prepared fields, add your SSN yourself, sign, attach evidence and submit to SSA. Supporting documents depend on your life event; this work-stoppage example is not a universal checklist. SSA decides the outcome.