Warsaw FBU Contact Form

All fields marked with an asterisk (*) are required

Select Inquiry Reason:*

Person Employed in the U.S.

Last Name:*

First Name:*

Maiden Name:

Year of Birth:*

Last 4 digits of Social Security Number:*

If you do not have/know your Social Security Number, please type four zeros (“0000”)

Claimant's Information (optional)

If other than person employed, such as wife, husband, child, widow, ex-spouse

Last Name:

First Name:

Maiden Name:

Year of Birth:

Last 4 digits of Social Security Number:

Claimaint’s Contact Information

Email Address:*

Enter Email Confirm Email

Telephone Number:*

Address*

Street Address Line 2 City ZIP / Postal Code Country

Remarks (Do not include your full social security number in the remarks field):*

The information you provide is used solely by the Federal Benefits Unit. In order to process certain types of requests, we may have to ask for your Social Security Number (SSN), your date of birth, your banking information and other information, please follow instructions on the Frequently Asked Questions for required information. You may decline to provide such information, but that could inhibit our ability to answer your questions or assist you with your request. Any information provided on our web form is not retained and is used only in order to process your current request or answer your current questions. The Federal Benefits Unit works in accordance with SSA procedures as well as the Paperwork Reduction Act (44 U.S.C. 3501 et seq.) and the Privacy Act of 1974. You can read our full privacy statement at http://www.socialsecurity.gov.

Emails and Privacy:
Email is not secure and any information you provide on this online enquiry form cannot be guaranteed safe from potential loss. If you choose to send us any Personally Identifiable Information in your email enquiry, it will be removed from the email before we send our reply.

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