Monthly Wage Reporting Participant Training Package

Supplemental 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
You should call to report wages during the first six (6) days of the month. You can
choose which of the six days to call. But, you will not be able to report wages
using the special 800 number after the sixth day of the month.
Things you need to have before you to report wages by telephone
; The Social Security number of the person who is reporting wages (the caller)
; The Social Security number of the wage earner
; The TOTAL amount of gross wages for the wage earner. Gross wages are the
amount of pay before taxes and other deductions.
; The Social Security number of the person who is eligible to receive SSI benefits
; 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 wages.

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 dollar and cents ($ 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 you will fill-in Line 1 and
Line 2.
If the wage earner is paid 3 times a month, you should you will fill-in Line 1, Line
2 and Line 3
If the wage earner is paid 4 times a month, you should you will fill-in Line 1, Line
2, Line3, and Line 4
If the wage earner is paid 5 times a month, you should you will 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 wages
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 earned.

Call 1-866-772-0953 now and make your report.

Paperwork Reduction Act Statement
See Revised PRA
Statement

This information collection meets the clearance requirements of 44 U.S.C. §3507,
as amended by section 2 of the Paperwork Reduction Act of 1995. You are not
required to answer these questions unless we display a valid Office of Management
and Budget control number. We estimate that it will take you an average of 5
minutes to read the instructions, gather the facts and respond.
You may send comments on our estimate of the time needed to complete the
Supplemental Security Income Telephone Wage Report - Instructions to: SSA,
6401 Security Blvd., Baltimore, MD 21235-6401. Send only comments relating to
our time estimate to this address, not the completed report. All requests for Social
Security cards and other claims-related information should be sent to your local
Social Security office.
The OMB control number for the Supplemental Security Income Telephone Wage
Reporting System and the associated instructions package is 0960-0715; expiration
date 09/30/2010.

Supplemental Security Income
Wages for October 2009
Wages for OCTOBER
S

M

T

W

Days to report in NOVEMBER

T
1

F
2

S
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 A

M

T

W

T

F

1

2

3

4

5

6

S

BOX B

Line Date October ___ ,
2009
1 Paid:
Line Date October ___ ,
2009
2 Paid:
Line Date October ___ ,
2009
3 Paid:
Line Date October ___ ,
2009
4 Paid:

Gross
Wages:

$

Gross
Wages:

$

Gross
Wages:

$

Gross
Wages:

$

Line Date October ___ , Gross
2009 Wages:
5 Paid:
Line Date October ___ , Gross
2009 Wages:
6 Paid:
BOX C

S

TOTAL
Gross Wages

$
$
$

,.
,.
,.
,.
,.
,.
,.

Ï
Use the TOTAL Gross Wages from BOX C when you report wages for
OCTOBER 2009
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 2009
Wages for NOVEMBER

Days to report in DECEMBER

S
1

M
2

T
3

W
4

T
5

F
6

S
7

S

8

9

10

11

12

13

14

6

15
22
29

16
23
30

17
24

18
25

19
26

20
27

21
28

BOX A

T

W

T

F

S

1

2

3

4

5

BOX B

Line Date November ___ , Gross
2009 Wages:
1 Paid:
Line Date November ___ , Gross
2009 Wages:
2 Paid:
Line Date November ___ , Gross
2009 Wages:
3 Paid:
Line Date November ___ , Gross
2009 Wages:
4 Paid:
Line Date November ___ , Gross
2009 Wages:
5 Paid:
Line Date November ___ , Gross
2009 Wages:
6 Paid:
BOX C

M

TOTAL
Gross
Wages

$
$
$
$
$
$
$

,.
,.
,.
,.
,.
,.
,.

Ï
Use the TOTAL Gross Wages from BOX C when you report wages for
NOVEMBER 2009
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 2009
Wages for DECEMBER
S

M

Days to report in JANUARY, 2010

T
1

W
2

T
3

F
4

S
5

S

3

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 A

4

T

5

W

T

F

S

1

2

6

BOX B

Line Date December ___ ,
2009
1 Paid:
Line Date December ___ ,
2009
2 Paid:
Line Date December ___ ,
2009
3 Paid:
Line Date December ___ ,
2009
4 Paid:

Gross
Wages:

$

Gross
Wages:

$

Gross
Wages:

$

Gross
Wages:

$

Line Date December ___ , Gross
2009 Wages:
5 Paid:
Line Date December ___ , Gross
2009 Wages:
6 Paid:
BOX C

M

TOTAL
Gross
Wages

$
$
$

,.
,.
,.
,.
,.
,.
,.

Ï
Use the TOTAL Gross Wages from BOX C when you report wages for
DECEMBER 2009
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 2010
Wages for JANUARY, 2010
S

M

T

W

T

Days to report in FEBRUARY

F
1

S
2

3

4

5

6

7

8

9

10
17
24
31

11
18
25

12
19
26

13
20
27

14
21
28

15
22
29

16
23
30

BOX A

M

T

W

T

F

S

1

2

3

4

5

6

BOX B

Line Date January ___ ,
2010
1 Paid:
Line Date January ___ ,
2010
2 Paid:
Line Date January ___ ,
2010
3 Paid:
Line Date January ___ ,
2010
4 Paid:

Gross
Wages:

$

Gross
Wages:

$

Gross
Wages:

$

Gross
Wages:

$

Line Date January ___ , Gross
2010 Wages:
5 Paid:
Line Date January ___ , Gross
2010 Wages:
6 Paid:
BOX C

S

TOTAL
Gross
Wages

$
$
$

,.
,.
,.
,.
,.
,.
,.

Ï
Use the TOTAL Gross Wages from BOX C when you report wages for
JANUARY 2010
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 2010
Wages for FEBRUARY
S

Days to report in MARCH

M
1

T
2

W
3

T
4

F
5

S
6

S

7

8

9

10

11

12

13

14
21
28

15
22

16
23

17
24

18
25

19
26

20
27

BOX A

T

W

T

F

S

1

2

3

4

5

6

BOX B

Line Date February ___,
2010
1 Paid:
Line Date February ___,
2010
2 Paid:
Line Date February ___,
2010
3 Paid:
Line Date February ___,
2010
4 Paid:

Gross
Wages:

$

Gross
Wages:

$

Gross
Wages:

$

Gross
Wages:

$

Line Date February ___, Gross
2010 Wages:
5 Paid:
Line Date February ___, Gross
2010 Wages:
6 Paid:
BOX C

M

TOTAL
Gross
Wages

$
$
$

,.
,.
,.
,.
,.
,.
,.

Ï
Use the TOTAL Gross Wages from BOX C when you report wages for
FEBRUARY 2010
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 2010
Wages for MARCH
S

Days to report in APRIL

M
1

T
2

W
3

T
4

F
5

S
6

S

7

8

9

10

11

12

13

4

14
21
28

15
22
29

16
23
30

17
24
31

18
25

19
26

20
27

BOX A

5

T

W

T

F

S

1

2

3

6

BOX B

Line Date March ___ ,
2010
1 Paid:
Line Date March ___ ,
2010
2 Paid:
Line Date March ___ ,
2010
3 Paid:
Line Date March ___ ,
2010
4 Paid:

Gross
Wages:

$

Gross
Wages:

$

Gross
Wages:

$

Gross
Wages:

$

Line Date March ___ , Gross
2010 Wages:
5 Paid:
Line Date March ___ , Gross
2010 Wages:
6 Paid:
BOX C

M

TOTAL
Gross
Wages

$
$
$

,.
,.
,.
,.
,.
,.
,.

Ï
Use the TOTAL Gross Wages from BOX C when you report wages for
MARCH 2010
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 2010
Wages for APRIL
S

M

T

W

Days to report in MAY

T
1

F
2

S
3

S

2

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

BOX A

T

W

T

F

S

1
3

4

5

6

BOX B

Line Date April ___ ,
2010
1 Paid:
Line Date April ___ ,
2010
2 Paid:
Line Date April ___ ,
2010
3 Paid:
Line Date April ___ ,
2010
4 Paid:

Gross
Wages:

$

Gross
Wages:

$

Gross
Wages:

$

Gross
Wages:

$

Line Date April ___ , Gross
2010 Wages:
5 Paid:
Line Date April ___ , Gross
2010 Wages:
6 Paid:
BOX C

M

TOTAL
Gross
Wages

$
$
$

,.
,.
,.
,.
,.
,.
,.

Ï
Use the TOTAL Gross Wages from BOX C when you report wages for
APRIL 2010
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 2010
Wages for MAY
S

M

T

W

T

Days to report in JUNE
F

S
1

S

6

2

3

4

5

6

7

8

9
16
23
30

10
17
24
31

11
18
25

12
19
26

13
20
27

14
21
28

15
22
29

BOX A

T

W

T

F

S

1

2

3

4

5

BOX B

Line Date May ___ ,
2010
1 Paid:
Line Date May ___ ,
2010
2 Paid:
Line Date May ___ ,
2010
3 Paid:
Line Date May ___ ,
2010
4 Paid:

Gross
Wages:

$

Gross
Wages:

$

Gross
Wages:

$

Gross
Wages:

$

Line Date May ___ , Gross
2010 Wages:
5 Paid:
Line Date May ___ , Gross
2010 Wages:
6 Paid:
BOX C

M

TOTAL
Gross
Wages

$
$
$

,.
,.
,.
,.
,.
,.
,.

Ï
Use the TOTAL Gross Wages from BOX C when you report wages for
MAY 2010
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 2010
Wages for JUNE
S

M

Days to report in JULY

T
1

W
2

T
3

F
4

S
5

S

4

6

7

8

9

10

11

12

13
20
27

14
21
28

15
22
29

16
23
30

17
24

18
25

19
26

BOX A

5

T

W

T

F

S

1

2

3

6

BOX B

Line Date June ___ ,
2010
1 Paid:
Line Date June ___ ,
2010
2 Paid:
Line Date June ___ ,
2010
3 Paid:
Line Date June ___ ,
2010
4 Paid:

Gross
Wages:

$

Gross
Wages:

$

Gross
Wages:

$

Gross
Wages:

$

Line Date June ___ , Gross
2010 Wages:
5 Paid:
Line Date June ___ , Gross
2010 Wages:
6 Paid:
BOX C

M

TOTAL
Gross
Wages

$
$
$

,.
,.
,.
,.
,.
,.
,.

Ï
Use the TOTAL Gross Wages from BOX C when you report wages for
JUNE 2010
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 2010
Wages for JULY
S

M

T

W

Days to report in AUGUST

T
1

F
2

S
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 A

M

T

W

T

F

1

2

3

4

5

6

S

BOX B

Line Date July ___ ,
2010
1 Paid:
Line Date July ___ ,
2010
2 Paid:
Line Date July ___ ,
2010
3 Paid:
Line Date July ___ ,
2010
4 Paid:

Gross
Wages:

$

Gross
Wages:

$

Gross
Wages:

$

Gross
Wages:

$

Line Date July ___ , Gross
2010 Wages:
5 Paid:
Line Date July ___ , Gross
2010 Wages:
6 Paid:
BOX C

S

TOTAL
Gross
Wages

$
$
$

,.
,.
,.
,.
,.
,.
,.

Ï
Use the TOTAL Gross Wages from BOX C when you report wages for
JULY 2010
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 2010
Wages for AUGUST

Days to report in SEPTEMBER

S
1

M
2

T
3

W
4

T
5

F
6

S
7

S

8

9

10

11

12

13

14

5

15
22
29

16
23
30

17
24
31

18
25

19
26

20
27

21
28

BOX A

T

W

T

F

S

1

2

3

4

6

BOX B

Line Date August ___ ,
2010
1 Paid:
Line Date August ___ ,
2010
2 Paid:
Line Date August ___ ,
2010
3 Paid:
Line Date August ___ ,
2010
4 Paid:

Gross
Wages:

$

Gross
Wages:

$

Gross
Wages:

$

Gross
Wages:

$

Line Date August ___ , Gross
2010 Wages:
5 Paid:
Line Date August ___ , Gross
2010 Wages:
6 Paid:
BOX C

M

TOTAL
Gross Wages

$
$
$

,.
,.
,.
,.
,.
,.
,.

Ï
Use the TOTAL Gross Wages from BOX C when you report wages for
AUGUST 2010
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 2010
Wages for SEPTEMBER
S

M

T

Days to report in OCTOBER

W
1

T
2

F
3

S
4

S

3

5

6

7

8

9

10

11

12
19
26

13
20
27

14
21
28

15
22
29

16
23
30

17
24

18
25

BOX A

4

T

5

W

T

F

S

1

2

6

BOX B

Line Date September ___ ,
2010
1 Paid:
Line Date September ___ ,
2010
2 Paid:
Line Date September ___ ,
2010
3 Paid:
Line Date September ___ ,
2010
4 Paid:

Gross
Wages:

$

Gross
Wages:

$

Gross
Wages:

$

Gross
Wages:

$

Line Date September ___ , Gross
2010 Wages:
5 Paid:
Line Date September ___ , Gross
2010 Wages:
6 Paid:
BOX C

M

TOTAL
Gross Wages

$
$
$

,.
,.
,.
,.
,.
,.
,.

Ï
Use the TOTAL Gross Wages from BOX C when you report wages for
September 2010
Call 1-866-772-0953 now and make your report
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS

SSA will insert the following revised PRA Statement into the form at its
next scheduled reprinting:
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. SEND OR
BRING THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY
OFFICE. You can find your local Social Security office through SSA’s website at
www.socialsecurity.gov. Offices are also listed under U. S. Government agencies in
your telephone directory or you may call Social Security at 1-800-772-1213 (TTY 1800-325-0778). 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.