Current SSA-2-INST

REPORTING RESPONSIBILITIES FOR WIFE'S OR HUSBAND'S INSURANCE BENEFITS
CHANGES TO BE REPORTED AND HOW TO REPORT
FAILURE TO REPORT MAY RESULT IN OVERPAYMENTS THAT MUST BE REPAID, AND IN
POSSIBLE MONETARY PENALTIES

You change your mailing address for checks or
residence. To avoid delay in receipt of checks you
should ALSO file a regular change of address notice
with your post office.
Your citizenship or immigration status changes.
Any beneficiary goes outside the U.S.A. for 30
consecutive days or longer.
Any beneficiary dies or becomes unable to handle
benefits.
Work Changes — On your application you told us
you expect total earnings for
to be
Year
$
.
You
than $

(are)

(are not) earning wages of more
a month.

You
(are)
(are not) self-employed rendering
substantial services in your trade or business.
(Report AT ONCE if this work pattern changes)
Change of Marital Status — Marriage, divorce,
annulment of marriage. You must report marriage
even if you believe that an exception applies.

Custody Change or Disability Improves — Report if a
person for whom you are filing, or who is in your
care dies, leaves your care or custody, changes
address, or, if disabled, the condition improves.

You are confined to jail, prison, penal institution or
correctional facility for conviction of a crime or
confined to a public institution by court order in
connection with a crime.

FORM SSA -2 -INST (04 -2006 ) (EF 04 -2006 ) Destroy prior editions

You have an unsatisfied warrant for your arrest for a
crime or attempted crime that is a felony (or, in
jurisdictions that do not define crimes as felonies, a
crime that is punishable by death or imprisonment
for a term exceeding 1 year.)
You have an unsatisfied warrant for a violation of
probation or parole under Federal or State law.
You begin to receive a government pension or
annuity (from the Federal government or any State
or any political subdivision thereof) or your pension
or annuity amount changes.
HOW TO REPORT
You can make your reports by telephone, mail,
or in person, whichever you prefer.
If you are awarded benefits, and one or more
of the above change(s) occur, you should
report by:
♦ Calling us TOLL FREE at 1-800-772-1213;
If you are deaf or hearing impaired, calling us
TOLL FREE at TTY 1-800-325-0778; or
♦ Calling, visiting or writing your local Social
Security office at the phone number and
address shown on your claim receipt.
For general information about Social Security,
visit our web site at www.socialsecurity.gov.
♦

For those under full retirement age, the law
requires that a report of earnings be filed with
SSA within 3 months and 15 days after the
end of any taxable year in which you earn
more than the annual exempt amount. You
may contact SSA to file a report. Otherwise,
SSA will use the earnings reported by your
employer(s) and your self-employment tax
return (if applicable) as the report of earnings
required by law, to adjust benefits under the
earnings test.
It is your responsibility to
ensure that the information you give
concerning your earnings is correct. You must
furnish additional information as needed when
your benefit adjustment is not correct based
on the earnings on your record.

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NOTICE ABOUT DOCUMENTS
We recommend that you keep all documents you submitted to us.
We are returning the documents you submitted with this claim.

Collection and Use of Information From Your Application Privacy Act Notice/Paperwork Reduction Act Notice
The Social Security Administration is authorized to collect the information requested on this form
under sections 202, 205 and 223 of the Social Security Act. The information you provide will be
used by the Social Security Administration to determine if you or a dependent is eligible to insurance
coverage and/or monthly benefits. You do not have to give us the requested information. However,
if you do not provide the information, we will be unable to make an accurate and timely decision
concerning your entitlement or a dependent's entitlement to benefit payments.
The information you provide may be disclosed to another Federal, State, or local government agency
for determining eligibility for a government benefit or program, to a Congressional office requesting
information on your behalf, to an independent party for the performance of research and statistical
activities, or to the Department of Justice for use in representing the Federal government.
We may also use this information when we match records by computer. Matching 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 qualifies for benefits paid by the Federal
government. The law allows us to do this even if you do not agree to it.

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 12.5 minutes
to read the instructions, gather the facts, and answer the questions. SEND OR BRING THE COMPLETED FORM TO
YOUR LOCAL SOCIAL SECURITY OFFICE. The office is listed under U. S. Government agencies in your telephone
directory or you may call Social Security at 1-800-772-1213. 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 form.

FORM SSA-2-INST (04-2006 ) (EF 04- 2006 ) Destroy prior editions

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