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pdfSocial Securit Administration
Retirement, Survivors and Disability Insurance
Important Information
i
!
Date:
,
Claim Number: ~ . # W - Z-,W$fd)
Y
I a m writing to ask your help in making suse that we are paying you the correct
amount of Social Security benefits. We need you to give us current information
a b u t your work.
C
culm-
,b
Earlier, you told us that your earnings this year would be about $.y ~ c x,
a Your phns,
however, may have changed. Because we want to make sure that we are paying
you accurately, we want you to che& your estimate for this year, and let us know
if it is different We also need know about y o u work plans for 200b
3'
The enclosed form has some questions about your work for this year and next yearAfter you complete it, please mail it ia the enclomd envelope. We need to hear from.
you as soon as possible, because we need to know if your estimate for 2006 is still
*ht.
b
Thank you for taking the time to assist us. We would like ta give you the best possible
sewice and hope that you find this form a convenient way to inform us about your work
plans.
If you have any questions, you can call us toll free at 1 -800-772-1
213,7:00 a.m. to
7:00 p.m. Monday through Friday. We can answer most q u e s ~ o n over
s
the phone.
Our busiest times are the first week of the month and Mondays. So, we may be able ta
handle your call more quickly if you can call us at other times. lf you prefer to visit or
call one of our offices, use the 800 l~umberand we can give you the office address and
telephone number. Please have this letter with you if you call o r visit an office. It w i l l
help us answer your questions.
Sincerely,
commissioner
Social Security Administration
Enclosures:
Ehmings Estimate Form SSA-L9781-SM
Envelope
Form SSA- LV8l -Sh1(%20d)
6
We have put together a list of questions that will help you update your earnings
estimate. Please answer them carefully. Before you answer our questions, we
want to talk briefly about how to estimate your earnings.
It may not be easy for you to figure ahead of time how much you w i l l make in
200$ and 2006. But if you keep these pointers in mind, you should have no problem.
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If you are paid wages, base your estimate on what you expect to earn before
taxes or other deductions for the whole year. Be sure to include bonuses,
vacation pay, sick pay, tips of $20 or more a month, and any contribution that
you make from your salary to a tax deferred savings plan
Drop from your estimate any money you will get from yaur employer &year
for work you did last year or before. Also, do not include:
a
Social Security, r a h a d or civil
service retirement, veterans,
black lung or public assistance
benefits;
&ts or inheritances;
pensions and other retirement
payments which are not
reported on your W-2 form;
rental income;
gain (or loss) from the sale of capital
assets;
unemployment or worker's
compensation;
investment income;
jury duty payments.
a interest from savings accounts;
life insurance annuities and
dividends;
If you a= self-employed,base your estimate on what you think yaur net
earnings will be - just Like on ur tax return If you became entitled t,a Social
Security benefits before 20$(I)
do not include %your estimate any Federal
agricultural program payments you expect in 200& and (2) do not include
seli-employment income received in 20
rom carry-overcrops for work you
did before you became entitled to Social ecurity benefits-
%
If you get both wages and income from self-employment, add the two amounts
tagether. The total is your estmate.
Form SSA- L9781 -SM(7 -200P)
0
Page 2
&1%n61cb! y&/
rn You will reach full retirement age in.-
Beginning with the month of full retirement age, the earnings limit no longer
applies. If you w i l l reach full retirement age in January
you do not have
to complete question 5 -ding
your earnings for 2 0 9 .
7
%q,
7
People who reach fuU retirement age in February through Dece ber 20M7
should exclude from their estimate of yearly earnings for ZOO$ ny wages earned
in the month they reach full retirement age and all fobwing months. Selfemployment income should be prorated based on the number of month under
full =tiremen t age. That is, divide expected net earnings (or loss) for 200 b~
the number of months of self-employment and multiply this result by
the number of months in 200%before you reach full retirement age
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Now,you are ready to answer the following questions about your earnings. And again,
Form SSA- L978l -SM(7-20~kj
G
Form Approved
OMB No. UWW
Page 1
For
Lb) w-gg-YW%
CL)
(d) m l y y
mhJ)'Y
1* How
Earlier, you told us
will earn
this year.
much do
now think you will earn in
rid.--
you
(; X K )
20019
you
6
Show your earnings for the whole year, including amounts you wiU
-both
before and after you filed for Social Security benefits.
Show your answer in the space below.
Wages
Net Self-EmploymentEarnings
Total Earnings
So faryou have figured out how much you plan to earn in 20&. Now you
need to go back, and estimate how much you wiU earn each We need
to know this because we pay you based on how much you will earn each month
if you make more than the earnings limit, which
to hoId back some of your Social S d t y . But if
to earn in each month in 2006 we may be able to
b
pay you more.
T h e same is true of sew-employedpeople. The difference is that we will need
to know how many born you work in each month, instead of the amount of
money you wjll earn.
b
For the following months in 2006, you previously told us that you will not
earn over $1,040and w i l l not work over 46 hours in self-employment.
44
MARCH A P E MAY JUNE JULY AUGUST SEPTEMBER OCTOBER
NOVEMBER DECEMBER
2. ifeachyoumonth
work for wages, put an
in the box under
when
will earn $1,090or less, B e sure
TP'
you
4
to do it for the whole year,
JAN PEB MAR APR MAY(JUN JUL AUG SEP OCT NOV DW:
*
Please go on to the next question.
Page 2
3. If you are self-employed, how many hours will you
work each month in ZOO$? Be sure to put something
down for each month, b
Show your hours in the boxes bebw.
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
To help us make sure that we understand your answers, we would like to
know if you bave retired, or if you plan to retire this year.
4. Have you retired, or do
you plan to retire in 20@?
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If you retired, or pla to retire from your regular (full-time)
employment in
nswer "YES" to this question even if you work or
plan to work
Show an "X" on the Line next to your answer.
NO,I have not retired and I am not going to retire this year.
YES, I have retired, o r plan to retire this yea?.
If you answered "yestt,please show your retirement date in the space
blow.
(MONTH, DAY, YEAR)
Please answer question 5 on the next page,
Form SSA-Lg'i81-SM (7-200h
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Page 3
If you will reach full retirement age in January 2006, you do not have to
complete this questbn.
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a
".f"
Our last uestion is about yourearningsin 200 . Please lookahead and
estimate ow much you plan to earn next y
We w i l l use this info- tion
to d
v how much we can pay you in 2006. If you do not plan to work in
2008, show "owas your stimated earnings amount. If you wiU attain fuU
retirement age in 2006, mdude only your earnirrgs prior ta the month you
become full mtirement age. You must answer this question, If you do
not enter an amount in question 5, w e will use your estimate for 2008
4
to decide Bow much to pay you in
1
F
%OM.
7
5
How much do you think you will earn in 20083
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Show your answer in the space below.
Remember, you need to return this form as soon as possible
Please sign this form in the space below, and send it back to us in the
enclosed envelope. And again, thadc you for your help.
1 declare under penalty of perjury that I have examined all the information
on this form, and on any accompanying smtements or forms, and it is true
and c o a c t to the best of my knowledge.
Your Signature
Date
Also, please give us a telephone number where we can reach you during the
day.
Area Code
Telephone Number
,
Form SSA-L9781-SM ( 7 - 2 4 )
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Page 4
PRIVACY ACT STATEmNT
The Social Security Administration (SSA) is a u t h o r s to collect information on
this form under section, 205 (a) and section 203 (h)(3), (4) of the Social Security Act.
Giving us this infomation i;s voluntary. You do not have to do it, but we may not be
paying you the right amount unless you give us this infomation.
We use the information you give us to insure that we are paying you correctly.
However, we may share this informakn with another person or government agency
to manage the Sacid Security program or other programs that must be mrdinated
with the SSA
We may also use the information you give us in computer matching programs.
Matching programs compare our records with those of other Federal, State, or local
govemment.agencies. Many agencies m a y use matching p-ms
to find or prove
that a person qualifies for benefits paid by the Federal Government The law allows
us ta do this even if you do not agree to it
Explanations a b u t these and other r e a m s why information you provide us may be
used or given out are availabLe in Social Security offices. If you want to learn more
about this, contact any Social Security office.
PAPER W O R K REDUCTION ACT STATEMENT
-
Paperwork Reduction Act Statement This information collection meets the
reguirements of 44 U.S.C.5 3507, as amended by Section 2 o f the Paaerwork
f 2995* You do not need to answer these questions d e s s we display
a valid office of Management and Budget control number. We estimate that it wiIT
&comments
on our time d i m a t e d o v e to: SSA, hY6
Baltimore, M D 21235-0001.
Form =A-L9781 -SM(7-2005)
File Type | application/pdf |
File Modified | 2006-10-04 |
File Created | 2006-10-04 |