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Social Security 360 Analyzer® Fact Finder
  • About you

    Answer the questions below and bring this form to a Social Security planning meeting with your advisor. (If you select married, widowed or divorced, be sure to answer the related questions on Page 2 in addition to the questions below.)
  • Government or Non-profit Employees/Former Employees

    If yes, Page 3 of your SS benefit statement “Your earnings statement” is required with this questionnaire to generate a report.
  • Your earnings

    For this section, please refer to a current Social Security benefit statement.
  • Your retirement income assumption

  • 1 Life expectancy for a married couple at age 65, 2015 LIMRA Retirement Income Reference Book

  • About your spouse

  • Government or Non-profit Employees/Former Employees

    If yes, Page 3 of your SS benefit statement “Your earnings statement” is required with this questionnaire to generate a report.
  • Your spouse earnings

    For this section, please refer to a current Social Security benefit statement.
  • If you’re widowed

    If eligible for survivor benefits you will need proof of marriage and death to retrieve benefits for a deceased spouse when you visit your local SSA office.
  • If you’re divorced

    You may be eligible for benefits based on an ex-spouse’s record, if you were married for at least 10 years. You will need proof of marriage and divorce to retrieve information and benefits for an ex-spouse when you visit your local SSA office.
  • • Not a deposit • Not FDIC or NCUSIF insured • Not guaranteed by the institution • Not insured by any federal government agency • May lose value The information collected on this questionnaire will be kept confidential and used to provide an estimate of your Social Security benefits in retirement. For more information on how Nationwide protects your personal information, visit our online privacy policy at www.nationwide.com/privacy-security.jsp. Keep in mind that any estimate resulting from this fact finder is for hypothetical purposes only and is not a guarantee. This material is not a recommendation to buy, sell, hold or roll over any asset, adopt an investment strategy, retain a specific investment manager or use a particular account type. It does not take into account the specific investment objectives, tax and financial condition, or particular needs of any specific person. Investors should work with their financial professional to discuss their specific situation. This is being provided for informational purposes only and should not be construed as investment, tax, or legal advice. The information provided is based on current laws, which are subject to change at any time, and has not been endorsed by any government agency. Nationwide Investment Services Corporation (NISC), member FINRA, Columbus, OH. Nationwide Retirement Institute is a division of NISC. Social Security 360 Analyzer is a service mark of Nationwide Life Insurance Company. Nationwide and the Nationwide N and Eagle are service marks of Nationwide Mutual Insurance Company. © 2019 Nationwide NFM-11991AO.9 (01/19)

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

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For Agent use only. Rates are subject to change. Certain exclusions, restrictions and limitations may apply; please contact your marketer for more information. Not affiliated with the United States government or the federal Medicare program.

We have done our best to ensure that the information provided on this website and the third party industry resources and services available or otherwise presented are accurate and provide valuable support. However, nothing available on or represented through this website should be understood as a recommendation or endorsement. By your use of this site, you agree not to attempt to hold us liable for any such decisions, actions or results, including any direct, indirect, consequential, special, exemplary or other damage that may result at any time, under any circumstance, as a result of any action pertaining to use of the information provided and the third party industry resources and services available or otherwise presented.

We have done our best to ensure that the information provided on this website and the third party industry resources and services available or otherwise presented are accurate and provide valuable support. However, nothing available on or represented through this website should be understood as a recommendation or endorsement. By your use of this site, you agree not to attempt to hold us liable for any such decisions, actions or results, including any direct, indirect, consequential, special, exemplary or other damage that may result at any time, under any circumstance, as a result of any action pertaining to use of the information provided and the third party industry resources and services available or otherwise presented.
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