Form SSA-131 Employer Report of Special Wage Payments

Social Security Administration
Retirement, Survivors and Disability Insurance
Date:
Employee's Name:
Employee's Social Security Number:

Please complete the attached form for tax year 2012. The information that you
provide will be used in making a determination regarding the amount of Social
Security benefits payable to the above named individual.
You may submit Special Wage Payment files electronically by visiting SSA's website
at www.socialsecurity.gov/employer, and selecting "Business Services Online
(BSO)." If you file electronically. please do not mail paper copies of these forms to
Wilkes-Barre Data Operations Center.
We would appreciate receiving this information by August 8, 2013. An envelope
requiring no postage is enclosed for your convenience. If you have any questions,
please call us at 1-800-772-6270 between 7:30a.m. and 4:00p.m. eastern time.
Sincerely,

Acting Commissioner of
Social Security

Enclosures:
Form SSA-131-0CR
Envelope

Form Approved
OMB No. 0960-0565
Social Securitv Administration

EMPLOYER REPORT OF SPECIAL WAGE PAYMENTS
PART 1 -TO BE COMPLETED BY SSA/EMPLOYER:
'l'ax Year

Employee Name

SSA Claim Number

Employee's SSN

(fo be completed by SSA)

Employer

Address

PART 2 - TO BE COMPLETED BY EMPLOYER:
~mployee~'l are oomc~t:imeR paid wagt!R in a yt?.a.r subs<1quent l'o the~ yene that tl1e wages were earned The most oommon typt!R of payments are
accumulatc:xl (for prior ye.am) vacation pay or sick pay paid after t'etin.ment; defetrixl oompensation; severance pay (when paid on a~ount of
retirement) arid bcmm;es- paid pursuant to a prior agt'L>ement or rontract.
Wa t~ which are earned ~· a ;y_ear p_n.·File Typeapplication/pdfFile Modified2013-10-29File Created2013-07-12