Monthly Wage Reporting Participant Training Package

Supplemental Security Income
Smartphone Wage Reporting
Application - 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 Android Play and Apple/iTunes Markets. 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
Report wages during the first 6 days of the month. You can choose which of the 6
days to report. However, you will not be able to report wages using your
smartphone application after the sixth day of the month. If you miss reporting
wages during the first 6 days of the month, report the wages to your local Social
Security office.

Things you need to report wages using your smartphone application
 The Social Security number of the person who is reporting wages (the
reporter)
 The Social Security number of the wage earner
 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 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 app)
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 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 earners 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 monthly wage reporting helps prevent SSI overpayments and
underpayments.
SSI Mobile Wage Reporting Application Access Code
You will use your secure access code to enter the application. Only you or the person
inputting your wages into the application should use this code. Please do not share your
Access Code with anyone else.
Your access code is AETJRBJ.

OMB 0960-0715

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 07/31/2013.

OMB 0960-0715

Supplemental Security Income
Wages for September 2012
Wages for SEPTEMBER
Su

Mo

Tu

We

Th

Fr

2
9
16
23
30

3
10
17
24

4
11
18
25

5
12
19
26

6
13
20
27

7
14
21
28

Days to report in OCTOBER
Sa
1
8
15
22
29

Su

BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6

Date
Paid:

Mo
1

Tu
2

We
3

Th
4

Fr
5

Sa
6

BOX B
___,
2012

Gross
Wages:

$,.
Date
___, Gross
Paid: September 2012 Wages:
$,.
Date
___, Gross
Paid: September 2012 Wages:
$,.
Date
___, Gross
Paid: September 2012 Wages:
$,.
Date
___, Gross
Paid: September 2012 Wages:
$,.
Date
___, Gross
Paid: September 2012 Wages:
$,.
TOTAL
Box C
Gross Wages $,.
September

Use the TOTAL Gross Wages from BOX C when you report wages for

September 2012
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS

OMB 0960-0715

Supplemental Security Income
Wages for October 2012
Wages for OCTOBER
Su
7
14
21
28

Mo
1
8
15
22
29

Tu
2
9
16
23
30

We
3
10
17
24
31

Th
4
11
18
25

Fr
5
12
19
26

Days to report in NOVEMBER
Sa
6
13
20
27

Su

Mo

Tu

4

5

6

BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6

Date
Paid:

We

Th
1

Fr
2

Sa
3

BOX B
___,
2012

Gross
Wages:

$,.
Date
___, Gross
Paid: October
2012 Wages:
$,.
Date
___, Gross
Paid: October
2012 Wages:
$,.
Date
___, Gross
Paid: October
2012 Wages:
$,.
Date
___, Gross
Paid: October
2012 Wages:
$,.
Date
___, Gross
Paid: October
2012 Wages:
$,.
TOTAL
Box C
Gross Wages $,.
October

Use the TOTAL Gross Wages from BOX C when you report wages for

October 2012
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS

OMB 0960-0715

Supplemental Security Income
Wages for November 2012
Wages for NOVEMBER
Su

Mo

Tu

We

4
11
18
25

5
12
19
26

6
13
20
27

7
14
21
28

Th
1
8
15
22
29

Fr
2
9
16
23
30

Days to report in DECEMBER
Sa
3
10
17
24

Su

Mo

Tu

We

Th

2

3

4

5

6

BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6

Date
Paid:

Fr

Sa
1

BOX B
___,
2012

Gross
Wages:

$,.
Date
___, Gross
Paid: November 2012 Wages:
$,.
Date
___, Gross
Paid: November 2012 Wages:
$,.
Date
___, Gross
Paid: November 2012 Wages:
$,.
Date
___, Gross
Paid: November 2012 Wages:
$,.
Date
___, Gross
Paid: November 2012 Wages:
$,.
TOTAL
Box C
Gross Wages $,.
November

Use the TOTAL Gross Wages from BOX C when you report wages for

November 2012
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS

OMB 0960-0715

Supplemental Security Income
Wages for December 2012
Wages for DECEMBER
Su

Mo

Tu

We

Th

Fr

2
9
16
23
30

3
10
17
24
31

4
11
18
25

5
12
19
26

6
13
20
27

7
14
21
28

Days to report in JANUARY
Sa
1
8
15
22
29

Su

Line
2
Line
3
Line
4
Line
5
Line
6

Date
Paid:

Tu
1

We
2

Th
3

Fr
4

Sa
5

6

BOX A
Line
1

Mo

BOX B
___,
2012

Gross
Wages:

$,.
Date
___, Gross
Paid: December 2012 Wages:
$,.
Date
___, Gross
Paid: December 2012 Wages:
$,.
Date
___, Gross
Paid: December 2012 Wages:
$,.
Date
___, Gross
Paid: December 2012 Wages:
$,.
Date
___, Gross
Paid: December 2012 Wages:
$,.
TOTAL
Box C
Gross Wages $,.
December

Use the TOTAL Gross Wages from BOX C when you report wages for

December 2012
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS

OMB 0960-0715

Supplemental Security Income
Wages for January 2013
Wages for JANUARY
Su

Mo

6
13
20
27

7
14
21
28

Tu
1
8
15
22
29

We
2
9
16
23
30

Th
3
10
17
24
31

Fr
4
11
18
25

Days to report in FEBRUARY
Sa
5
12
19
26

Su

Mo

Tu

We

3

4

5

6

BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6

Date
Paid:

Th

Fr
1

Sa
2

BOX B
___,
2013

Gross
Wages:

$,.
Date
___, Gross
Paid: January
2013 Wages:
$,.
Date
___, Gross
Paid: January
2013 Wages:
$,.
Date
___, Gross
Paid: January
2013 Wages:
$,.
Date
___, Gross
Paid: January
2013 Wages:
$,.
Date
___, Gross
Paid: January
2013 Wages:
$,.
TOTAL
Box C
Gross Wages $,.
January

Use the TOTAL Gross Wages from BOX C when you report wages for

January 2013
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS

OMB 0960-0715

Supplemental Security Income
Wages for February 2013
Wages for FEBRUARY
Su

Mo

Tu

We

Th

3
10
17
24

4
11
18
25

5
12
19
26

6
13
20
27

7
14
21
28

Fr
1
8
15
22

Days to report in MARCH
Sa
2
9
16
23

Su

Mo

Tu

We

3

4

5

6

BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6

Date
Paid:

Th

Fr
1

Sa
2

BOX B
___,
2013

Gross
Wages:

$,.
Date
___, Gross
Paid: February
2013 Wages:
$,.
Date
___, Gross
Paid: February
2013 Wages:
$,.
Date
___, Gross
Paid: February
2013 Wages:
$,.
Date
___, Gross
Paid: February
2013 Wages:
$,.
Date
___, Gross
Paid: February
2013 Wages:
$,.
TOTAL
Box C
Gross Wages $,.
February

Use the TOTAL Gross Wages from BOX C when you report wages for

February 2013
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS

OMB 0960-0715

Supplemental Security Income
Wages for March 2013
Wages for MARCH
Su

Mo

Tu

We

Th

3
10
17
24
31

4
11
18
25

5
12
19
26

6
13
20
27

7
14
21
28

Days to report in APRIL
Fr
1
8
15
22
29

Sa
2
9
16
23
30

Su

BOX A
Line
1
Line
2
Line
3
Line
4
Line
5
Line
6

Date
Paid:

Mo
1

Tu
2

We
3

Th
4

Fr
5

Sa
6

BOX B
___,
2013

Gross
Wages:

$,.
Date
___, Gross
Paid: March
2013 Wages:
$,.
Date
___, Gross
Paid: March
2013 Wages:
$,.
Date
___, Gross
Paid: March
2013 Wages:
$,.
Date
___, Gross
Paid: March
2013 Wages:
$,.
Date
___, Gross
Paid: March
2013 Wages:
$,.
TOTAL
Box C
Gross Wages $,.
March

Use the TOTAL Gross Wages from BOX C when you report wages for

March 2013
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS

OMB 0960-0715

Supplemental Security Income
Wages for April 2013
Wages for APRIL
Su
7
14
21
28

Mo
1
8
15
22
29

Tu
2
9
16
23
30

We
3
10
17
24

Days to report in MAY

Th
4
11
18
25

Fr
5
12
19
26

Sa
6
13
20
27

Su

Mo

5

6

BOX A
Line
1

Date
Paid:

April

Line
2

Date
Paid:

April

Line
3

Date
Paid:

April

Line
4

Date
Paid:

April

Line
5

Date
Paid:

April

Line
6

Date
Paid:

April

Box C

Tu

We
1

Th
2

Fr
3

Sa
4

BOX B
___,
2013

Gross
Wages:

$,.
___, Gross
2013 Wages:
$,.
___, Gross
2013 Wages:
$,.
___, Gross
2013 Wages:
$,.
___, Gross
2013 Wages:
$,.
___, Gross
2013 Wages:
$,.
TOTAL
Gross Wages $,.

Use the TOTAL Gross Wages from BOX C when you report wages for

April 2013
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS

OMB 0960-0715

Supplemental Security Income
Wages for May 2013
Wages for MAY
Su

Mo

Tu

5
12
19
26

6
13
20
27

7
14
21
28

We
1
8
15
22
29

Days to report in JUNE
Th
2
9
16
23
30

Fr
3
10
17
24
31

Sa
4
11
18
25

Su

Mo

Tu

We

Th

2

3

4

5

6

BOX A
Line
1

Date
Paid:

May

Line
2

Date
Paid:

May

Line
3

Date
Paid:

May

Line
4

Date
Paid:

May

Line
5

Date
Paid:

May

Line
6

Date
Paid:

May

Box C

Fr

Sa
1

BOX B
___,
2013

Gross
Wages:

$,.
___, Gross
2013 Wages:
$,.
___, Gross
2013 Wages:
$,.
___, Gross
2013 Wages:
$,.
___, Gross
2013 Wages:
$,.
___, Gross
2013 Wages:
$,.
TOTAL
Gross Wages $,.

Use the TOTAL Gross Wages from BOX C when you report wages for

May 2013
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS