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pdfSupplemental Security Income
Telephone Wage Report Instructions
Beneficiaries, deemors and representative payees reporting a change in wages can
report their monthly wages to SSA by telephone. These instructions explain what
beneficiaries, deemors, and representative payees need to do in order to use the
SSA phone system to report monthly wages. Using the following charts to help
you calculate your monthly wages is voluntary. Beneficiaries, deemors and
representative payees who would rather not report wages by telephone can use
traditional reporting methods such as mailing or bringing paystubs into their local
Social Security office. Monthly telephone reporters who experience technical
difficulties should contact their local field office for assistance.
When you should call to report wages
Please report wages during the first six days of the month to help prevent an
incorrect SSI payment. You can choose which of the 6 days to call. If you miss
reporting during the 6 day reporting period at the beginning of the month, you can
still report the wages over the phone or report to your local Social Security office.
Things you need to have before you to report wages by telephone
The caller’s Social Security number – this is the person actually calling to
report the wages
The Social Security number of the wage earner - this is the person working
The TOTAL amount of gross wages received by the wage earner. Gross wages
are the amount of pay before taxes and other deductions
The caller’s name as it appears on their Social Security card
How to figure the total wages for each month
Fill in the blanks on the attached worksheets. Use your worksheet to report wages
when you call the 800 number.
Who is the Wage Earner?
A wage earner is the person who is working and receiving wages or payment for
working. You are the wage earner if you are working and you are reporting your
own wages. If you are calling to report someone else’s wages, then the wage
earner is the person whose wages you are reporting.
How to fill-in the worksheet
Date Paid
Use Box A to show the date paid (payday).
Date Paid is the date (Month, Day, Year) the wage earner is paid (pay day).
Gross Wages
Use Box B to show the gross amount of wages.
Enter dollars and cents ($ X,XXX. cc).
Use the wage earner’s pay stub to find the gross wages. Gross wages are the
amount of pay before taxes and other deductions. Do not enter net wages, the
amount of take home pay on the paycheck, or the direct deposit amount to your
bank. Do not enter the total wages for the year, also called the year-to-date (YTD)
amount.
Use a Separate Line for Each Pay
You should fill-in a line for each pay date in a month.
If the wage earner is paid 2 times a month, you should fill-in Line 1 and Line 2.
If the wage earner is paid 3 times a month, you should fill-in Line 1, Line 2 and
Line 3.
If the wage earner is paid 4 times a month, you should fill-in Line 1, Line 2,
Line 3, and Line 4.
If the wage earner is paid 5 times a month, you should fill-in Line 1, Line 2,
Line 3, Line 4 and Line 5.
If the wage earner gets an extra check for special pay such as an award, bonus, or
unused vacation, or any other reason, use a separate line to enter the pay date and
gross wages.
How Wage Earner Paid
Paid Weekly
Paid Bi-Weekly (Every 2 Weeks)
Paid Bi-Monthly
Paid Monthly
Number of Pays a Month
4 Pays or 5 Pays
2 or 3 Pays
2 Pays
1 Pay
Total Gross Wages
Use Box C to enter the total amount of gross wages.
Add together all gross wages in Box B for each line where you have wage
amounts. This is your total. Put the total in Box C TOTAL.
Please double check that you only include dates and amounts that you received in
the month shown at the top of the page.
You are now ready to call in and report total gross wages received.
IMPORTANT: Please be sure to report wages from a quiet location, since
background noise may cause the report to fail.
Remember, consistent and timely monthly wage reporting helps prevent SSI
overpayments and underpayments.
Call 1-866-772-0953 now and make your report.
Wage Reporting Reminder
You can now sign up for email or text reminders to report monthly wages for SSI
at www.socialsecurity.gov/ssiwagereporting.
Paperwork Reduction Act Statement
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 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 06/30/2016.
OMB 0960-0715
Supplemental Security Income
Wages for October 2013
Wages for OCTOBER
S
M
Days to report in NOVEMBER
T
1
W
2
T
3
F
4
S
5
S
3
4
5
6
10
17
24
11
18
25
12
19
26
13
20
27
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6
T
W
T
F
S
1
2
7
8
9
14
21
28
15
22
29
16
23
30
BOX B
Date October ___ ,
2013
Paid:
Date October ___ ,
2013
Paid:
Date October ___ ,
2013
Paid:
Date October ___ ,
2013
Paid:
Gross
Wages:
$
Gross
Wages:
$
Gross
Wages:
$
Gross
Wages:
$
Date October ___ , Gross
2013 Wages:
Paid:
Date October ___ , Gross
2013 Wages:
Paid:
BOX C
M
TOTAL
Gross Wages
$
$
$
,.
,.
,.
,.
,.
,.
,.
Use the TOTAL Gross Wages from BOX C when you report wages for
OCTOBER 2013
Call 1-866-772-0953 now and make your report
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS
Supplemental Security Income
Wages for November 2013
Wages for NOVEMBER
S
M
T
W
T
3
4
5
6
10
11
12
17
18
24
25
Days to report in DECEMBER
7
F
1
8
S
2
9
S
M
T
W
T
F
1
2
3
4
5
6
S
7
16
8
15
9
16
10
17
11
18
12
19
13
20
14
21
13
14
15
19
20
21
22
23
22
23
24
25
26
27
28
26
27
28
29
30
29
30
31
BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6
BOX B
Date November ___ , Gross
2013 Wages:
Paid:
Date November ___ , Gross
2013 Wages:
Paid:
Date November ___ , Gross
2013 Wages:
Paid:
Date November ___ , Gross
2013 Wages:
Paid:
Date November ___ , Gross
2013 Wages:
Paid:
Date November ___ , Gross
2013 Wages:
Paid:
BOX C
TOTAL
Gross Wages
$
$
$
$
$
$
$
,.
,.
,.
,.
,.
,.
,.
Use the TOTAL Gross Wages from BOX C when you report wages for
NOVEMBER 2013
Call 1-866-772-0953 now and make your report
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS
Supplemental Security Income
Wages for December 2013
Wages for DECEMBER
S
M
T
W
T
F
Days to report in JANUARY 2014
S
S
T
W
T
F
S
1
2
3
4
1
2
3
4
5
6
7
8
9
10
11
12
13
14
5
6
7
8
9
10
11
15
16
17
18
19
20
21
12
13
14
15
16
17
18
22
23
24
25
26
27
28
19
20
21
22
23
24
25
29
30
31
26
27
28
29
30
31
BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6
M
BOX B
Date December ___ ,
2013
Paid:
Date December ___ ,
2013
Paid:
Date December ___ ,
2013
Paid:
Date December ___ ,
2013
Paid:
Gross
Wages:
$
Gross
Wages:
$
Gross
Wages:
$
Gross
Wages:
$
Date December ___ , Gross
2013 Wages:
Paid:
Date December ___ , Gross
2013 Wages:
Paid:
BOX C
TOTAL
Gross Wages
$
$
$
,.
,.
,.
,.
,.
,.
,.
Use the TOTAL Gross Wages from BOX C when you report wages for
DECEMBER 2013
Call 1-866-772-0953 now and make your report
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS
Supplemental Security Income
Wages for January 2014
Wages for JANUARY, 2014
S
M
T
W
T
F
Days to report in FEBRUARY
S
S
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
W
T
F
S
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
BOX B
Date January
Paid:
___ ,
2014
Gross
Wages:
$
Date January
Paid:
___ ,
2014
Gross
Wages:
$
Date January
Paid:
___ ,
2014
Gross
Wages:
$
Date January
Paid:
___ ,
2014
Gross
Wages:
$
Date January
Paid:
___ ,
2014
Gross
Wages:
$
Date January
Paid:
___ ,
2014
Gross
Wages:
$
BOX C
T
1
BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6
M
TOTAL Gross
Wages
$
,.
,.
,.
,.
,.
,.
,.
Use the TOTAL Gross Wages from BOX C when you report wages for
JANUARY 2014
Call 1-866-772-0953 now and make your report
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS
Supplemental Security Income
Wages for February 2014
Wages for FEBRUARY
S
M
T
W
T
F
Days to report in MARCH
S
S
M
T
W
T
F
S
1
1
2
3
4
5
6
7
8
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
9
16
23
10
17
24
11
18
25
12
19
26
13
20
27
14
21
28
15
22
29
30
31
BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6
BOX B
Date February ___,
2014
Paid:
Date February ___,
2014
Paid:
Date February ___,
2014
Paid:
Date February ___,
2014
Paid:
Gross
Wages:
$
Gross
Wages:
$
Gross
Wages:
$
Gross
Wages:
$
Date February ___, Gross
2014 Wages:
Paid:
Date February ___, Gross
2014 Wages:
Paid:
BOX C
TOTAL
Gross Wages
$
$
$
,.
,.
,.
,.
,.
,.
,.
Use the TOTAL Gross Wages from BOX C when you report wages for
FEBRUARY 2014
Call 1-866-772-0953 now and make your report
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS
Supplemental Security Income
Wages for March 2014
Wages for MARCH
S
M
T
2
3
9 10
16 17
23 24
30 31
W
4
11
18
25
T
5
12
19
26
F
6
13
20
27
7
14
21
28
Days to report in APRIL
S
1
8
15
22
29
BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6
M
T
W
T
F
S
1
2
3
4
5
6
7
8
9
10
11
12
13
20
14
21
15
22
16
23
17
24
18
25
19
26
27
28
29
30
BOX B
Date March ___ ,
2014
Paid:
Date March ___ ,
2014
Paid:
Date March ___ ,
2014
Paid:
Date March ___ ,
2014
Paid:
Gross
Wages:
$
Gross
Wages:
$
Gross
Wages:
$
Gross
Wages:
$
Date March ___ , Gross
2014 Wages:
Paid:
Date March ___ , Gross
2014 Wages:
Paid:
BOX C
S
TOTAL
Gross Wages
$
$
$
,.
,.
,.
,.
,.
,.
,.
Use the TOTAL Gross Wages from BOX C when you report wages for
MARCH 2014
Call 1-866-772-0953 now and make your report
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS
Supplemental Security Income
Wages for April 2014
Wages for APRIL
S
M
T
W
T
Days to report in MAY
F
S
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
27
21
28
22
29
23
30
24
25
26
BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6
S
T
W
T
F
S
1
2
3
4
5
6
7
8
9
10
11
18
25
12
19
26
13
20
27
14
21
28
15
22
29
16
23
30
17
24
31
BOX B
Date April ___ , Gross
2014 Wages:
Paid:
Date April ___ , Gross
2014 Wages:
Paid:
Date April ___ , Gross
2014 Wages:
Paid:
Date April ___ , Gross
2014 Wages:
Paid:
Date April ___ , Gross
2014 Wages:
Paid:
Date April ___ , Gross
2014 Wages:
Paid:
BOX C
M
TOTAL
Gross Wages
$
$
$
$
$
$
$
,.
,.
,.
,.
,.
,.
,.
Use the TOTAL Gross Wages from BOX C when you report wages for
APRIL 2014
Call 1-866-772-0953 now and make your report
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS
Supplemental Security Income
Wages for May 2014
Wages for MAY
S
M
T
W
T
Days to report in JUNE
F
S
1
2
3
1
2
3
4
5
6
S
7
M
T
W
T
F
4
5
6
7
8
9
10
8
9
10
11
12
13
14
11
12
13
14
15
16
17
15
16
17
18
19
20
21
18
19
20
21
22
23
24
22
23
24
25
26
27
28
25
26
27
28
29
30
31
29
30
BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6
S
BOX B
Date May ___ ,
2014
Paid:
Date May ___ ,
2014
Paid:
Gross
Wages:
$
Gross
Wages:
$
Date May ___ , Gross
2014 Wages:
Paid:
Date May ___ , Gross
2014 Wages:
Paid:
Date May ___ , Gross
2014 Wages:
Paid:
Date May ___ , Gross
2014 Wages:
Paid:
BOX C
TOTAL
Gross Wages
$
$
$
$
$
,.
,.
,.
,.
,.
,.
,.
Use the TOTAL Gross Wages from BOX C when you report wages for
MAY 2014
Call 1-866-772-0953 now and make your report
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS
Supplemental Security Income
Wages for June 2014
Wages for JUNE
S
M
T
W
T
Days to report in JULY
F
S
1
8
2
9
3
10
4
11
5
12
6
13
7
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6
M
T
W
T
F
S
1
2
3
4
5
6
7
8
9
10
11
12
13
20
27
14
21
28
15
22
29
16
23
30
17
24
31
18
25
19
26
BOX B
Date June ___ ,
2014
Paid:
Date June ___ ,
2014
Paid:
Date June ___ ,
2014
Paid:
Date June ___ ,
2014
Paid:
Gross
Wages:
$
Gross
Wages:
$
Gross
Wages:
$
Gross
Wages:
$
Date June ___ , Gross
2014 Wages:
Paid:
Date June ___ , Gross
2014 Wages:
Paid:
BOX C
S
TOTAL
Gross Wages
$
$
$
,.
,.
,.
,.
,.
,.
,.
Use the TOTAL Gross Wages from BOX C when you report wages for
JUNE 2014
Call 1-866-772-0953 now and make your report
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS
Supplemental Security Income
Wages for July 2014
Wages for JULY
S
M
T
W
T
Days to report in AUGUST
F
S
1
2
3
4
5
M
T
W
T
F
S
1
2
6
7
8
9
10
11
12
3
4
5
6
7
8
9
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
10
17
24
31
11
18
25
12
19
26
13
20
27
14
21
28
15
22
29
16
23
30
BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6
S
BOX B
Date July ___ ,
2014
Paid:
Date July ___ ,
2014
Paid:
Date July ___ ,
2014
Paid:
Date July ___ ,
2014
Paid:
Gross
Wages:
$
Gross
Wages:
$
Gross
Wages:
$
Gross
Wages:
$
Date July ___ , Gross
2014 Wages:
Paid:
Date July ___ , Gross
2014 Wages:
Paid:
BOX C
TOTAL
Gross Wages
$
$
$
,.
,.
,.
,.
,.
,.
,.
Use the TOTAL Gross Wages from BOX C when you report wages for
JULY 2014
Call 1-866-772-0953 now and make your report
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS
Supplemental Security Income
Wages for August 2014
Wages for AUGUST
S
M
T
W
T
Days to report in SEPTEMBER
F
S
S
1
2
T
W
T
F
S
1
2
3
4
5
6
3
4
5
6
7
8
9
7
8
9
10
11
12
13
10
17
24
31
11
18
25
12
19
26
13
20
27
14
21
28
15
22
29
16
23
30
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6
M
BOX B
Date August ___ , Gross
2014 Wages:
Paid:
Date August ___ , Gross
2014 Wages:
Paid:
Date August ___ , Gross
2014 Wages:
Paid:
Date August ___ , Gross
2014 Wages:
Paid:
Date August ___ , Gross
2014 Wages:
Paid:
Date August ___ , Gross
2014 Wages:
Paid:
BOX C
TOTAL
Gross Wages
$
$
$
$
$
$
$
,.
,.
,.
,.
,.
,.
,.
Use the TOTAL Gross Wages from BOX C when you report wages for
AUGUST 2014
Call 1-866-772-0953 now and make your report
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS
Supplemental Security Income
Wages for September 2014
Wages for SEPTEMBER
S
M
T
W
T
F
Days to report in OCTOBER
S
S
7
1
8
2
9
3
10
4
11
5
12
6
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6
T
W
T
F
S
1
2
3
4
5
6
7
8
9
10
11
12
19
26
13
20
27
14
21
28
15
22
29
16
23
30
17
24
31
18
25
BOX B
Date September ___ ,
2014
Paid:
Date September ___ ,
2014
Paid:
Date September ___ ,
2014
Paid:
Date September ___ ,
2014
Paid:
Gross
Wages:
$
Gross
Wages:
$
Gross
Wages:
$
Gross
Wages:
$
Date September ___ , Gross
2014 Wages:
Paid:
Date September ___ , Gross
2014 Wages:
Paid:
BOX C
M
TOTAL
Gross Wages
$
$
$
,.
,.
,.
,.
,.
,.
,.
Use the TOTAL Gross Wages from BOX C when you report wages for
September 2014
Call 1-866-772-0953 now and make your report
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS
Supplemental Security Income
Mobile Wage Reporting Instructions
Beneficiaries, deemors and representative payees reporting a change in wages
can report their monthly wages via the SSI Mobile Wage Reporting Application
available in the Google Play and Apple App Stores. These instructions explain
what beneficiaries, deemors, and representative payees need to do in order to use
the smartphone applications to report monthly wages. Using the following charts
to help you calculate your monthly wages is voluntary. Beneficiaries, deemors
and representative payees who would rather not report wages by smartphone
application can use traditional reporting methods such as mailing or bringing
paystubs into their local Social Security office. Monthly reporters who
experience technical difficulties should contact their local field office for
assistance.
When you should report wages
Please report wages during the first six days of the month to help prevent an
incorrect SSI payment. You can choose which of the 6 days to report. If you miss
reporting during the 6 day reporting period at the beginning of the month, you can
still report the wages using the smartphone application or at your local Social
Security office.
Things you need to have before you to report wages by smartphone
The user’s Social Security number (this is the person actually using the
smartphone to report the wages)
The Social Security number of the wage earner (this is the person working)
The TOTAL amount of gross wages received by the wage earner. Gross wages
are the amount of pay before taxes and other deductions
The reporter’s (user’s) name as it appears on their Social Security card
How to figure the total wages for each month
Fill in the blanks on the attached worksheets. Use your worksheet to report wages
when you use your smartphone application.
Who is the Wage Earner?
A wage earner is the person who is working and receiving wages or payment for
working. You are the wage earner if you are working and you are reporting your
own wages. If you are reporting someone else’s wages, then the wage earner is the
person whose wages you are reporting.
How to Download the SSI Mobile
Wage Reporting App to Your Device
Android
On your mobile device (from the Google Play Store)
1. Click the "Google Play" icon. Click the "Search icon" on your screen and type
“SSI Mobile Wage Reporting” into the search bar that appears.
2. Navigate to the SSI Mobile Wage Reporting application and tap to select it the details screen will appear, and you can read more about the app, its
features and the developer.
3. Tap the Download button.
4. Tap Accept & download to accept the permissions for the app - your item will
start downloading immediately.
Apple/iTunes
On your mobile device (from the Apple App Store)
1. Click the "App Store" icon on the home screen of your iPhone. Click
"Search" at the bottom of the screen and type “SSI Mobile Wage Reporting”
into the search bar that appears.
2. Tap the icon that appears to reach additional information about the app,
including developer notes, screen shots and user ratings.
3. To download the SSI Mobile Wage Reporting app tap the button that contains
the word "Free." Once the download status bar under the new icon on your
iPhone has completed, you can access and begin using the new app.
How to Report Wages Using the Smartphone Application
1. If you are reporting wages for yourself or for another person, always enter
your own information on the first screen that asks for information even if you are
not the beneficiary (this screen appears after the Terms of Service, titled “Tell Us
Who You Are”).
2. If you are reporting wages for yourself, you enter and confirm your own gross
wages. (You already entered your SSN in the previous screen).
Note: If you are reporting wages as a parent or wage earner and your child
receives SSI, only enter your own information. You do not need to enter your
child’s SSN. Your SSN is connected to your child’s record, so therefore the
report is posted properly.
3. If you are reporting wages for “other persons,” you are to input the Social
Security number of the person who earned his/her wages in the “Enter SSN and
Wages” screen.
Note: Always enter wages of the wage earner, not the beneficiary. If you are a
parent reporting wages, but your spouse is the wage earner, you will enter your
spouse’s SSN and gross wages earned.
4. If you are reporting wages for yourself and another person, you enter your own
information first and after a successful submission, you will see a “Submit More
Wages” button. You select this button to begin to submit wages for the other
person. You will enter their SSN and their wages; there is no need to enter your
own information again.
How to fill-in the worksheet
Date Paid
Use Box A to show the date paid (payday).
Date Paid is the date (Month, Day, Year) the wage earner is paid (pay day).
Gross Wages
Use Box B to show the gross amount of wages.
Enter dollars and cents ($ X,XXX. cc).
Use the wage earner’s pay stub to find the gross wages. Gross wages are the
amount of pay before taxes and other deductions. Do not enter net wages, the
amount of take home pay on the paycheck, or the direct deposit amount to your
bank. Do not enter the total wages for the year, also called the year-to-date (YTD)
amount.
Use a Separate Line for Each Pay
You should fill-in a line for each pay date in a month.
If the wage earner is paid 2 times a month, you should fill-in Line 1 and Line 2.
If the wage earner is paid 3 times a month, you should fill-in Line 1, Line 2 and
Line 3.
If the wage earner is paid 4 times a month, you should fill-in Line 1, Line 2,
Line 3, and Line 4.
If the wage earner is paid 5 times a month, you should fill-in Line 1, Line 2,
Line 3, Line 4 and Line 5.
If the wage earner gets an extra check for special pay such as an award, bonus, or
unused vacation, or any other reason, use a separate line to enter the pay date and
gross wages.
How Wage Earner Paid
Paid Weekly
Paid Bi-Weekly (Every 2 Weeks)
Paid Bi-Monthly
Paid Monthly
Number of Pays a Month
4 Pays or 5 Pays
2 or 3 Pays
2 Pays
1 Pay
Total Gross Wages
Use Box C to enter the total amount of gross wages.
Add together all gross wages in Box B for each line where you have wage
amounts. This is your total. Put the total in Box C TOTAL.
Please double check that you only include dates and amounts that you received in
the month shown at the top of the page.
You are now ready to report total gross wages received.
Remember, consistent and timely monthly wage reporting helps prevent SSI
overpayments and underpayments.
Wage Reporting Reminder
You can now sign up for email or text reminders to report monthly wages for SSI
at www.socialsecurity.gov/ssiwagereporting.
Paperwork Reduction Act Statement
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 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 Wage Reporting
and the associated instructions package is 0960-0715; expiration date 06/30/2016.
OMB 0960-0715
Supplemental Security Income
Wages for October 2013
Wages for OCTOBER
S
M
Days to report in NOVEMBER
T
1
W
2
T
3
F
4
S
5
S
3
4
5
6
10
17
24
11
18
25
12
19
26
13
20
27
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6
T
W
T
F
S
1
2
7
8
9
14
21
28
15
22
29
16
23
30
BOX B
Date October ___ ,
2013
Paid:
Date October ___ ,
2013
Paid:
Date October ___ ,
2013
Paid:
Date October ___ ,
2013
Paid:
Gross
Wages:
$
Gross
Wages:
$
Gross
Wages:
$
Gross
Wages:
$
Date October ___ , Gross
2013 Wages:
Paid:
Date October ___ , Gross
2013 Wages:
Paid:
BOX C
M
TOTAL
Gross Wages
$
$
$
,.
,.
,.
,.
,.
,.
,.
Use the TOTAL Gross Wages from BOX C when you report wages for
OCTOBER 2013
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS
Supplemental Security Income
Wages for November 2013
Wages for NOVEMBER
S
M
T
W
T
3
4
5
6
10
11
12
17
18
24
25
Days to report in DECEMBER
7
F
1
8
S
2
9
S
M
T
W
T
F
1
2
3
4
5
6
S
7
16
8
15
9
16
10
17
11
18
12
19
13
20
14
21
13
14
15
19
20
21
22
23
22
23
24
25
26
27
28
26
27
28
29
30
29
30
31
BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6
BOX B
Date November ___ , Gross
2013 Wages:
Paid:
Date November ___ , Gross
2013 Wages:
Paid:
Date November ___ , Gross
2013 Wages:
Paid:
Date November ___ , Gross
2013 Wages:
Paid:
Date November ___ , Gross
2013 Wages:
Paid:
Date November ___ , Gross
2013 Wages:
Paid:
BOX C
TOTAL
Gross Wages
$
$
$
$
$
$
$
,.
,.
,.
,.
,.
,.
,.
Use the TOTAL Gross Wages from BOX C when you report wages for
NOVEMBER 2013
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS
Supplemental Security Income
Wages for December 2013
Wages for DECEMBER
S
M
T
W
T
F
Days to report in JANUARY 2014
S
S
T
W
T
F
S
1
2
3
4
1
2
3
4
5
6
7
8
9
10
11
12
13
14
5
6
7
8
9
10
11
15
16
17
18
19
20
21
12
13
14
15
16
17
18
22
23
24
25
26
27
28
19
20
21
22
23
24
25
29
30
31
26
27
28
29
30
31
BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6
M
BOX B
Date December ___ ,
2013
Paid:
Date December ___ ,
2013
Paid:
Date December ___ ,
2013
Paid:
Date December ___ ,
2013
Paid:
Gross
Wages:
$
Gross
Wages:
$
Gross
Wages:
$
Gross
Wages:
$
Date December ___ , Gross
2013 Wages:
Paid:
Date December ___ , Gross
2013 Wages:
Paid:
BOX C
TOTAL
Gross Wages
$
$
$
,.
,.
,.
,.
,.
,.
,.
Use the TOTAL Gross Wages from BOX C when you report wages for
DECEMBER 2013
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS
Supplemental Security Income
Wages for January 2014
Wages for JANUARY, 2014
S
M
T
W
T
F
Days to report in FEBRUARY
S
S
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
W
T
F
S
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
BOX B
Date January
Paid:
___ ,
2014
Gross
Wages:
$
Date January
Paid:
___ ,
2014
Gross
Wages:
$
Date January
Paid:
___ ,
2014
Gross
Wages:
$
Date January
Paid:
___ ,
2014
Gross
Wages:
$
Date January
Paid:
___ ,
2014
Gross
Wages:
$
Date January
Paid:
___ ,
2014
Gross
Wages:
$
BOX C
T
1
BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6
M
TOTAL Gross
Wages
$
,.
,.
,.
,.
,.
,.
,.
Use the TOTAL Gross Wages from BOX C when you report wages for
JANUARY 2014
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS
Supplemental Security Income
Wages for February 2014
Wages for FEBRUARY
S
M
T
W
T
F
Days to report in MARCH
S
S
M
T
W
T
F
S
1
1
2
3
4
5
6
7
8
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
9
16
23
10
17
24
11
18
25
12
19
26
13
20
27
14
21
28
15
22
29
30
31
BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6
BOX B
Date February ___,
2014
Paid:
Date February ___,
2014
Paid:
Date February ___,
2014
Paid:
Date February ___,
2014
Paid:
Gross
Wages:
$
Gross
Wages:
$
Gross
Wages:
$
Gross
Wages:
$
Date February ___, Gross
2014 Wages:
Paid:
Date February ___, Gross
2014 Wages:
Paid:
BOX C
TOTAL
Gross Wages
$
$
$
,.
,.
,.
,.
,.
,.
,.
Use the TOTAL Gross Wages from BOX C when you report wages for
FEBRUARY 2014
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS
Supplemental Security Income
Wages for March 2014
Wages for MARCH
S
M
T
2
3
9 10
16 17
23 24
30 31
W
4
11
18
25
5
12
19
26
T
6
13
20
27
F
7
14
21
28
Days to report in APRIL
S
1
8
15
22
29
BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6
M
T
W
T
F
S
1
2
3
4
5
6
7
8
9
10
11
12
13
20
14
21
15
22
16
23
17
24
18
25
19
26
27
28
29
30
BOX B
Date March ___ , Gross
2014 Wages:
Paid:
Date March ___ , Gross
2014 Wages:
Paid:
Date March ___ , Gross
2014 Wages:
Paid:
Date March ___ , Gross
2014 Wages:
Paid:
Date March ___ , Gross
2014 Wages:
Paid:
Date March ___ , Gross
2014 Wages:
Paid:
BOX C
S
TOTAL
Gross Wages
$
$
$
$
$
$
$
,.
,.
,.
,.
,.
,.
,.
Use the TOTAL Gross Wages from BOX C when you report wages for
MARCH 2014
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS
Supplemental Security Income
Wages for April 2014
Wages for APRIL
S
M
T
W
T
Days to report in MAY
F
S
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
27
21
28
22
29
23
30
24
25
26
BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6
S
T
W
T
F
S
1
2
3
4
5
6
7
8
9
10
11
18
25
12
19
26
13
20
27
14
21
28
15
22
29
16
23
30
17
24
31
BOX B
Date April ___ , Gross
2014 Wages:
Paid:
Date April ___ , Gross
2014 Wages:
Paid:
Date April ___ , Gross
2014 Wages:
Paid:
Date April ___ , Gross
2014 Wages:
Paid:
Date April ___ , Gross
2014 Wages:
Paid:
Date April ___ , Gross
2014 Wages:
Paid:
BOX C
M
TOTAL
Gross Wages
$
$
$
$
$
$
$
,.
,.
,.
,.
,.
,.
,.
Use the TOTAL Gross Wages from BOX C when you report wages for
APRIL 2014
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS
Supplemental Security Income
Wages for May 2014
Wages for MAY
S
M
T
W
T
Days to report in JUNE
F
S
1
2
3
1
2
3
4
5
6
S
7
M
T
W
T
F
4
5
6
7
8
9
10
8
9
10
11
12
13
14
11
12
13
14
15
16
17
15
16
17
18
19
20
21
18
19
20
21
22
23
24
22
23
24
25
26
27
28
25
26
27
28
29
30
31
29
30
BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6
S
BOX B
Date May ___ ,
2014
Paid:
Date May ___ ,
2014
Paid:
Gross
Wages:
$
Gross
Wages:
$
Date May ___ , Gross
2014 Wages:
Paid:
Date May ___ , Gross
2014 Wages:
Paid:
Date May ___ , Gross
2014 Wages:
Paid:
Date May ___ , Gross
2014 Wages:
Paid:
BOX C
TOTAL
Gross Wages
$
$
$
$
$
,.
,.
,.
,.
,.
,.
,.
Use the TOTAL Gross Wages from BOX C when you report wages for
MAY 2014
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS
Supplemental Security Income
Wages for June 2014
Wages for JUNE
S
M
T
W
T
Days to report in JULY
F
S
1
8
2
9
3
10
4
11
5
12
6
13
7
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6
M
T
W
T
F
S
1
2
3
4
5
6
7
8
9
10
11
12
13
20
27
14
21
28
15
22
29
16
23
30
17
24
31
18
25
19
26
BOX B
Date June ___ ,
2014
Paid:
Date June ___ ,
2014
Paid:
Date June ___ ,
2014
Paid:
Date June ___ ,
2014
Paid:
Gross
Wages:
$
Gross
Wages:
$
Gross
Wages:
$
Gross
Wages:
$
Date June ___ , Gross
2014 Wages:
Paid:
Date June ___ , Gross
2014 Wages:
Paid:
BOX C
S
TOTAL
Gross Wages
$
$
$
,.
,.
,.
,.
,.
,.
,.
Use the TOTAL Gross Wages from BOX C when you report wages for
JUNE 2014
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS
Supplemental Security Income
Wages for July 2014
Wages for JULY
S
M
T
W
T
Days to report in AUGUST
F
S
1
2
3
4
5
M
T
W
T
F
S
1
2
6
7
8
9
10
11
12
3
4
5
6
7
8
9
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
10
17
24
31
11
18
25
12
19
26
13
20
27
14
21
28
15
22
29
16
23
30
BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6
S
BOX B
Date July ___ ,
2014
Paid:
Date July ___ ,
2014
Paid:
Date July ___ ,
2014
Paid:
Date July ___ ,
2014
Paid:
Gross
Wages:
$
Gross
Wages:
$
Gross
Wages:
$
Gross
Wages:
$
Date July ___ , Gross
2014 Wages:
Paid:
Date July ___ , Gross
2014 Wages:
Paid:
BOX C
TOTAL
Gross Wages
$
$
$
,.
,.
,.
,.
,.
,.
,.
Use the TOTAL Gross Wages from BOX C when you report wages for
JULY 2014
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS
Supplemental Security Income
Wages for August 2014
Wages for AUGUST
S
M
T
W
T
Days to report in SEPTEMBER
F
S
S
1
2
T
W
T
F
S
1
2
3
4
5
6
3
4
5
6
7
8
9
7
8
9
10
11
12
13
10
17
24
31
11
18
25
12
19
26
13
20
27
14
21
28
15
22
29
16
23
30
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6
M
BOX B
Date August ___ ,
2014
Paid:
Date August ___ ,
2014
Paid:
Gross
Wages:
$
Gross
Wages:
$
Date August ___ , Gross
2014 Wages:
Paid:
Date August ___ , Gross
2014 Wages:
Paid:
Date August ___ , Gross
2014 Wages:
Paid:
Date August ___ , Gross
2014 Wages:
Paid:
BOX C
TOTAL
Gross Wages
$
$
$
$
$
,.
,.
,.
,.
,.
,.
,.
Use the TOTAL Gross Wages from BOX C when you report wages for
AUGUST 2014
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS
Supplemental Security Income
Wages for September 2014
Wages for SEPTEMBER
S
M
T
W
T
F
Days to report in OCTOBER
S
S
7
1
8
2
9
3
10
4
11
5
12
6
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6
T
W
T
F
S
1
2
3
4
5
6
7
8
9
10
11
12
19
26
13
20
27
14
21
28
15
22
29
16
23
30
17
24
31
18
25
BOX B
Date September ___ , Gross
2014 Wages:
Paid:
Date September ___ , Gross
2014 Wages:
Paid:
Date September ___ , Gross
2014 Wages:
Paid:
Date September ___ , Gross
2014 Wages:
Paid:
Date September ___ , Gross
2014 Wages:
Paid:
Date September ___ , Gross
2014 Wages:
Paid:
BOX C
M
TOTAL
Gross Wages
$
$
$
$
$
$
$
,.
,.
,.
,.
,.
,.
,.
Use the TOTAL Gross Wages from BOX C when you report wages for
SEPTEMBER 2014
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS
| File Type | application/pdf |
| Author | Taz Wicks-Simmons |
| File Modified | 2013-07-22 |
| File Created | 2013-07-22 |