Form Ssa-L-93-Sm (04-11) - Retirement, Survivors And Disability Insurance Form Page 3

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If You Have Any Questions
If you have any questions not answered by the enclosed pamphlet or the website, please write to us at the
above address or call us at 1-800-772-6270 between 7:00 A.M. and 7:00 P.M., Eastern time, Monday
through Friday.
Social Security Administration
999999999-99-MMDDYY
SSA-L-93-SM (04-11)

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