Supplemental Security Income Mobile Wage Reporting (SSIMWR)

Mobile SSI Wage Reporting Screen Package
Screen Images and Interactions
Access Code Entry

SSIMWR

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Mobile SSI Wage Reporting Screen Package
Terms of Service

Full Terms of Service wording:



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

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

I understand that this application contains U.S. Government information.
I consent to the monitoring of my use of this application to ensure its appropriate use.
I understand that it is a federal crime to:
·
Give false or misleading statements to obtain information in Social Security records; or
·
Deceive the Social Security Administration of an individual’s identity.
I understand that unauthorized use of, or access to, this application may subject me to criminal
or civil penalties, or both.
I understand that if I am submitting wages for someone else, I must have his or her permission
to do so.
I understand that Social Security may stop me from using this service if it finds or suspects
misuse.

SSIMWR

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Enter PII
1st Appearance of Screen
(Before Errors - Empty)

SSIMWR

2nd / 3rd Appearance of Screen
(After Errors - prepopulated)

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Confirm PII
Standard Name Display

SSIMWR

With Other Last Name Displayed

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Reporting Path Choice

SSIMWR

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Wage Entry for Self

SSIMWR

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Confirm Wage Report for Self

SSIMWR

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SSN and Wage Entry for Other
1st Appearance of Screen
(Before Errors - Empty)

SSIMWR

2nd / 3rd Appearance of Screen
(After Errors - prepopulated)

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Confirm Wage Report for Other

SSIMWR

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Interim Successful Submission

SSIMWR

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Final Successful Submission

SSIMWR

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Log Out Confirmation

SSIMWR

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Mobile SSI Wage Reporting Screen Package
Privacy Act Statement

Full Privacy Act Statement Wording:

Sections 205(a) and 1631 of the Social Security Act (42 U.S.C. §§ 405a, 1383), as amended, and
Executive Order 9397, as amended, authorize us to collect information needed for wage
reporting, including your Social Security number. We will use the information you provide us to
determine eligibility for Supplemental Security Income.
Furnishing us this information is voluntary. However, failing to provide us with all or part of the
information could prevent us from making an accurate and timely decision on Supplemental
Security Income benefits.
We rarely use the information you supply for any purpose other than for making a determination
relating to Supplemental Security Income benefits. However, we may use it for the
administration and integrity of Social Security programs. We also may disclose information to
another person or to another agency in accordance with approved routine uses, which include but
are not limited to the following:

SSIMWR

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Mobile SSI Wage Reporting Screen Package
1. To enable a third party or an agency to assist Social Security in establishing rights to
Social Security benefits and/or coverage;
2. To comply with Federal laws requiring the release of information from Social
Security records (e.g., to the Government Accountability Office and Department of
Veterans’ Affairs);
3. To make determinations for eligibility in similar health and income maintenance
programs at the Federal, State, and local level; and,
4. To facilitate statistical research, audit, or investigative activities necessary to assure
the integrity and improvement of Social Security programs (e.g., to the Bureau of the
Census and private entities under contract to Social Security).
We may also use the information you provide in computer matching programs. Matching
programs compare our records with records kept by other Federal, State, or local government
agencies. We use information from these matching programs to establish or verify a person’s
eligibility for federally funded or administered benefit programs and for repayment of payments
or delinquent debts under these programs.
A complete list of routine uses for this information is available in Systems of Records Notice
below
for
entitled, Supplemental Security IncomeSee
Record,
60-0103.
This notice, additional information,
Privacy
and information regarding our programsrevised
and systems
areAct
available on-line at
www.socialsecurity.gov or at your localStatement
Social Security office.

SSIMWR

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Mobile SSI Wage Reporting Screen Package
Paperwork Reduction Act

3

Full Paperwork Reduction Act Wording:
This information collection meets the requirements of 44 U.S.C. §3507, as amended by section 2 of
the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display
a valid Office of Management and Budget control number. We estimate that it will take about 5
3
minutes to read the instructions, gather the facts, and answer the questions.
You may send comments on our time estimate above to: SSA, 6401 Security Blvd., Baltimore, MD
21235-6401. Send only comments relating to our time estimate to this address, not the
completed report.
The OMB control number for the Supplemental Security Income Telephone Wage Reporting System and
the associated instructions package is 0960-0715; expiration date 07/31/2013.

SSIMWR

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Mobile SSI Wage Reporting Screen Package
Error Message Screens
Wage Reporting Period Closed

SSIMWR

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Service Unavailable

SSIMWR

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Cannot Connect

SSIMWR

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Access Code Error: 1st and 2nd Strikes

SSIMWR

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Access Code Error: 3rd Strike

SSIMWR

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In-line Field Error (example)

SSIMWR

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Verification/Exclusion Check Error: 1st and 2nd Strikes

SSIMWR

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Verification/Exclusion Check Error: 3rd Strike

SSIMWR

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Terms of Service Refusal

SSIMWR

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Time Out Warning

SSIMWR

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Time Out Error

SSIMWR

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Close This App Warning

SSIMWR

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Privacy Act Statement
Collection and Use of Personal Information
Sections 205a and 1631 of the Social Security Act (42 U.S.C. §§ 405a, 1383), as amended, and
Executive Order 9397, as amended, authorize us to collect this information, including your
Social Security number. We will use the information you provide us to determine eligibility for
Supplemental Security Income.
Furnishing us this information is voluntary. However, failing to provide us with all or part of the
information could prevent us from making an accurate and timely decision on Supplemental
Security Income benefits.
We rarely use the information you supply for any purpose other than for making a determination
relating to Supplemental Security Income benefits. However, we may use it for the
administration and integrity of Social Security programs. We may also disclose information to
another person or to another agency in accordance with approved routine uses, which include but
are not limited to the following:
1. To enable a third party or an agency to assist Social Security in establishing rights to
Social Security benefits and/or coverage;
2. To comply with Federal laws requiring the release of information from Social
Security records (e.g., to the Government Accountability Office and Department of
Veterans’ Affairs);
3. To make determinations for eligibility in similar health and income maintenance
programs at the Federal, State, and local level; and,
4. To facilitate statistical research, audit, or investigative activities necessary to assure
the integrity and improvement of Social Security programs (e.g., to the Bureau of the
Census and private entities under contract with us).
We may also use the information you provide in computer matching programs. Matching
programs compare our records with records kept by other Federal, State, or local government
agencies. Information from these matching programs can be used to establish or verify a person’s
eligibility for federally-funded or administered benefit programs and for repayment of payments
or delinquent debts under these programs.
A complete list of routine uses for this information is available in Systems of Records Notice
entitled, Supplemental Security Income Record, 60-0103. This notice, additional information,
and information regarding our programs and systems, are available on-line at
www.socialsecurity.gov or at your local Social Security office.