SSA-L9785 Retirement, Survivors and Disability Insurance: Earnings

Social Security Administration
Retirement, Survivors and Disabiliity Insurance

Important Information

I

Date: j

*

1 am writing to ask your help in making sure that we are paying you the correct
mount of Social Security bmdita. We need you to give us current information
about your work.
Earnings in t e months before a person becomes full retirement age ( m e ntly
age 65 and 6 onths for people born in 194#'and gradually inmesing t o 67 for
persons born. in 1960 or later) can reduce the amount of Social Security benets.
Because we want to make sure that we pay you accurately, we want you to give
us an earnings estimate for this year.

k

The enclosed farm has some questions about yqur work for this year. After you
complete it, pleaae mail it in the enclosed envelope. We need to hear &om you
as soon as possible.
Thank you for taking the time ta assist us. W e would like to give you the best
possible service and hope that you &d this form a convenient way to inform us
about your work.

If you have any questions, you can call us toll fiee at 1-800-772-1213,7:00
a.m. to
7:00 p.m. Monday through Friday. We can answer most questions over the phone.
Our busiest times are the fist week of the month and Mondays. So, we may be
able to handle your c a l l more quickly if you can call us a t other times. If you prefer
to visit or c d one of our &ces, use the 800 number and w e can give you the office
address and telephone number. Please have this letter with you if you call or visit
an office. It wiU help us answer your questions.

Commiesioner
Social Security Administration

Enclosures:
Earnings Estimate Form SSA-L9785 -SM
Envelope

Form SSA-L9785-SM (7-2006

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to E s a a t e Your-E

20

4

I
full retirement age far people born in 1944 ~ E Iage 65 anti# months. If .
on the fist day of the month, we consider you to have reached full PpCdI
retirement age in the prior month. For example, if your birthday is duakl, we treat
+
you as if you reached full retirement age in November. This means if you were born
@p\h
1, 194@ you only have to report wages for January through October.
Question f shows the month you will reach full retirement age.

If you wereborn

4b

gh January 1, 1 9 ~ you
: will reach full
retirement age in 20w(age 65 and o n t h s ) . This means you only have to report
wages for the months before you reach full retirement age in 200,d. Question 1
shows the month you w i l l reach full retirement age.
6
2, 1994thm

If you are paid wages, base your estimate on what you expect to e m before taxes or
other deductions up to the month you become .fullretirement age. Be sure to
include bonuses, vacation pay, sick pay, tips of $20 or more a month, and any
contribution that you make &om your salary to a tax deferred savings plan.

Drop from your estimah any money you w i l l get from your employer prior to the
month yinx are full retirement age for work you did last year or before. Also,
do not include:
Social Security, railroad or civil
service xetirement, veterans,
black lung or public assistance
benefits;
pensions and other retirement
payments which are not .
reported an your W-2 form;

gifts or inheritances;

+ gain (or loss) horn the sale of capital
assets;
a

rental income;

a

unemployment or worker's
compensation;

investment income;
interest from savings accounts;

Me insurance annuities and
dividends;

If you are sdf-employed, base your estimate on what you think your net
earnings willbe - justlike on our tax return, Ifyou became entitled to Social

Security ben6ta before 200kl)do notincludein ourestimate any Federal
200i(&d (2) do not include
agricultural program payments you exp&in
om carry-avercrops for work you
self-employment income received in 20
did before you became entitled to Social Security bendits.

*

If you are self-employed, we will reduce your estimated self-employment earnings
to adjust for the period you are full retirement age and over.

Now, you are ready t o answer the following questions about your earnings. And again,
om vow

Form SSA-L9785-SMC S - ~ W ~ I

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Fotln Approved

(:)MB NO.0930-0969

Page I

1

ntmv \
How much dolyou think you will have earned this year in
(f-)

wages before M,
the month you are full
retirement age in 20 9

%

Show your answer in the space below.

2

How much do you think you will earn in self-employment
in 2006f

6

If you are self-employed,we w i l l reduce your estimated self-employment
earnings to adjust for the period you are full retirement age and over.
Show your net self-employment earnings for the whole yeax in the space
below,

Your M

y Ear-

-

Now you need t o go back, and estimate how much you will earn
We need ta h a w this
vou b
n
!
h
o
w
onth.

' PLfo
,*

I

~ r k like
s this. Usually, if you make more than the earnings h i t , which ia 2006L

we have to hold back some of yo Social Security. But if w e h o w how
much you plan to earn in each month.* 2 0 3 before full retirement age we may be
b
able to pay you more.

1

The same is true of self-employed people. The Merence is that we will need to
h o w how many hours you work in each manth before full retirement age, instead of
the amount of money you will earn.
Please go on to the next question.

Form SSA-18785-SM (7-2006)

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Page 2

b

For the following months in 2006, you previously told us that you will not
earn over $ 2 , a and win not work over 45 hours in self-employment.

3

If you work for wages, put an
gach month when you will
including the month sou become full retirement age.
JAN FZB MAR APR MAY .JITN JUI; AUG SEP OCT NOV DEC
A

4. Ifwork each
are selfemployed, ow many hours will
month in
6. to but not including the
you
-

you

- 200d
--

month you become full retirement age.
Show your hours in the boxes below.

JAN FXB MAR APR MAY

Please go an t o the next question.

a jITL

AUG SEP OCT NOV DEC

0)>nc$- $@-->I$*$&I

Page 3

To help us make sure that we understand your answers, we would like to know if
you have retired, or if you plan to retire this year.

Have you retired, or do you blan to retire in 2 0 0 6 ~

6

If you retired, or pl to retire h m your regular (full-time)
empIoyment in 2 0 0 k s a e r 'YEST7to this question even if you work or
plan to work part-time.

Show an "X' on the h e next to your answer.

NO, I have not retired and I am not going to retire this year.

-YES,I have retired, or plan to retire thisyear.
If you answered ''yes'',please show your retirement date in the space
below.

(MONTH, DAY, YEAR)
Remember, you need to return this form as soon as possible.

Please sign this form in fie space below, and send it back to us in the
endosed envelope. And again, thank you for your help.
1 declare under penalty of perjury that I. have examined a l l the infarmation
on this fom, and on a n y accompanying statements or forms, and it is true
and correct to the best of my knowledge.

Date

Your Signature

Also, please give us a telephone number where we can reach you during the
dayI

Area Code

Telephone Number

Form $SA-L97#6SM 0-200b

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Page 4

PRIVACY ACT STATEMENT

T h e Social Security Administration (SSA) is authorized to collect information on
this form under section 205 (a) and section 203 (h) (31, (4) of the ,WSecurity ActGiving us this infomation is voluntary. You do not have to do it, but we may not be
paying you the right amount unless you give us this information.
We use the infomation you give us to insure that we are paying you comedy.
However, we may share this infomation with another person or government agency
to manage the Social Security program or other programs that must be coordinated
with the SSA.

We may also use the information you dve us in computer matching programs.
Makhhg programs compare our records with those of other Federal, State, or local
government agencies. Many agencies may use matching programs to find or prove
that a person q u a M e s for benefits paid by the Federal Government. The law allows
us to do this even if you do not agree to it.
Explanations about these and other reasons why information you provide us may be
used or given out are available in Sdcial S k t y o h s . If you want to learn more
about this, contact any Social Security office.

PAPERWORK REDUCTION ACT STATEMENT

Paperwork Reduction Act Statement - This information collection meets the
requirements of 44 U.S.C. 4 3607, as amended by Section 2 of the PztDerwork.
uctxon Act of 1995, You do not need to answer these questions unless we -lay

To find the nearest office, d 1-800-772-1213.Send
-time
estimate above to: SSA,
Baltimore, MD 21235-0001,