Certification of Request for Benefits or MediCare

 

Certification of Request for Benefits or MediCare

  • Phone Numbers (add Country Code if not in UK):
  • If You Are Married please also complete
  • The information you provide is used solely by the Federal Benefits Unit of the U.S. Embassy London. In order to process certain types of requests, we may have ask for your Social Security Number (SSN) or the last 4-digits thereof, your date of birth, or your banking 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 London FBU Office 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