Planning Questionnaire — SSBC Retirement Prep

Before you begin

A few simple sections, at your own pace.

Completing this questionnaire before contacting us helps us prepare for your situation and offer more personalized guidance. Please do not include a Social Security number, account password, or other login information.

For your protectionDo not enter a Social Security number, bank or routing number, medical records, account password, or other highly sensitive information in this form. If sensitive information or documents are needed, you will receive a secure client-portal request after your consultation. Please do not send sensitive information by email or text message.

1About you
2Family
3Work
4Business
5Benefits
6Confirm

1. Personal information

What would you like help with?

Full name

Address

City

State

ZIP code

Phone number

Birth date (MM/DD/YYYY)

City of birth

State/province and country of birth

Did you serve in the U.S. military before 1968?

2. Marital status

Share only the details that apply. Do not include a spouse’s or former spouse’s Social Security number.

Marital status

If married, have you been married at least one year?

If divorced, did a prior marriage last more than 10 years?

Do you have children?

Are any children under 18?

Were any children disabled before age 22?

Current or former spouse’s full name

Current or former spouse’s birth date (MM/DD/YYYY)

Marriage date (MM/DD/YYYY)

Marriage city, state/province, and country

Divorce date, if applicable (MM/DD/YYYY)

Children who may be eligible based on your work record

3. Employment income

Last year’s Social Security wages (W-2)

Estimated gross wages this year

3. Current work status

Are you currently working?

If not, last date worked (MM/DD/YYYY)

3. Recent work history

Optional, but helpful for planning. Please do not include a Social Security number.

Work during the past five years

4. Self-employment

Type of business

If not incorporated, last year’s Schedule C net earnings

Estimated net earnings this year

5. Other information

Do you currently receive any of these Social Security benefits? For disability-claim help, please contact us before sharing medical information or records.

Retirement

Medicare

Widow/widower benefit

Disability

If yes, gross monthly benefit amount

Month and year benefits started (MM/YYYY)

Do you plan to stop work or significantly reduce earnings?

If yes, planned retirement date (MM/DD/YYYY)

Who referred you to SSBC Retirement Prep?

Anything else you would like us to know?

6. Your acknowledgments

I have read the service details and fees, and understand that my actual price will be agreed to before paid work begins.

I have or will download my Social Security Statement, review my earnings record, and provide it for my planning review.

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Let’s start with the details that matter.

A few simple sections, at your own pace.