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
Report wages during the first 6 days of the month. You can choose which of the 6
days to call. But, you will not be able to report wages using the special 800
number 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 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 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 monthly wage reporting helps prevent SSI
overpayments and underpayments.

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

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 October 2012
Wages for OCTOBER
S

M
1

7
14
21
28

T
2

8
15
22
29

W
3

9
16
23
30

T
4

10
17
24
31

11
18
25

F
5
12
19
26

Days to report in NOVEMBER
S
6
13
20
27

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

4

M

5

T

W

T

F

S

1

2

3

6

BOX B

Date October ___ ,
2012
Paid:
Date October ___ ,
2012
Paid:
Date October ___ ,
2012
Paid:
Date October ___ ,
2012
Paid:

Gross
Wages:

$

Gross
Wages:

$

Gross
Wages:

$

Gross
Wages:

$

Date October ___ , Gross
2012 Wages:
Paid:
Date October ___ , Gross
2012 Wages:
Paid:

BOX C

S

TOTAL
Gross Wages

$
$
$

,.
,.
,.
,.
,.
,.
,.


Use the TOTAL Gross Wages from BOX C when you report wages for
OCTOBER 2012
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 2012
Wages for NOVEMBER
S

M

T

W

Days to report in DECEMBER

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

W

T

F

S

3

4

5

6

BOX B

Date November ___ ,
2012
Paid:
Date November ___ ,
2012
Paid:
Date November ___ ,
2012
Paid:
Date November ___ ,
2012
Paid:

Gross
Wages:

$

Gross
Wages:

$

Gross
Wages:

$

Gross
Wages:

$

Date November ___ , Gross
2012 Wages:
Paid:
Date November ___ , Gross
2012 Wages:
Paid:

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
NOVEMBER 2012
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 2012
Wages for DECEMBER
S

M

T

W

T

F

Days to report in JANUARY,
2013

S

2

3

4

5

6

7

1
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

6

M

T

W

T

F

S

1

2

3

4

5

BOX B

Date December ___ , Gross
2012 Wages:
Paid:
Date December ___ , Gross
2012 Wages:
Paid:
Date December ___ , Gross
2012 Wages:
Paid:
Date December ___ , Gross
2012 Wages:
Paid:
Date December ___ , Gross
2012 Wages:
Paid:
Date December ___ , Gross
2012 Wages:
Paid:

BOX C

S

TOTAL
Gross Wages

$
$
$
$
$
$
$

,.
,.
,.
,.
,.
,.
,.


Use the TOTAL Gross Wages from BOX C when you report wages for
DECEMBER 2012
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 2013
Wages for JANUARY, 2013
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
20
27

14
21
28

15
22
29

16
23
30

17
24
31

18
25

19
26

3

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

4

T

5

W

T

F

S

1

2

6

BOX B

Date January
Paid:

___ ,
2013

Gross
Wages:

$

Date January
Paid:

___ ,
2013

Gross
Wages:

$

Date January
Paid:

___ ,
2013

Gross
Wages:

$

Date January
Paid:

___ ,
2013

Gross
Wages:

$

Date January
Paid:

___ ,
2013

Gross
Wages:

$

Date January
Paid:

___ ,
2013

Gross
Wages:

$

BOX C

M

TOTAL Gross
Wages

$

,.
,.
,.
,.
,.
,.
,.


Use the TOTAL Gross Wages from BOX C when you report wages for
JANUARY 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 February 2013
Wages for FEBRUARY
S

M

T

W

T

F

Days to report in MARCH
S

S

3

4

5

6

7

1
8

2
9

10

11

12

13

14

15

16

17
24

18
25

19
26

20
27

21
28

22

23

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

4

T

5

W

T

F

S

1

2

6

BOX B

Date February ___, Gross
2013 Wages:
Paid:
Date February ___, Gross
2013 Wages:
Paid:
Date February ___, Gross
2013 Wages:
Paid:
Date February ___, Gross
2013 Wages:
Paid:
Date February ___, Gross
2013 Wages:
Paid:
Date February ___, Gross
2013 Wages:
Paid:

BOX C

3

M

TOTAL
Gross Wages

$
$
$
$
$
$
$

,.
,.
,.
,.
,.
,.
,.


Use the TOTAL Gross Wages from BOX C when you report wages for
FEBRUARY 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 March 2013
Wages for MARCH
S

M

T

W

T

Days to report in APRIL

F

S

S

1

2

3

4

5

6

7

8

9

10
17
24

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

T

W

T

F

S

1

2

3

4

5

6

BOX B

Date March ___ , Gross
2013 Wages:
Paid:
Date March ___ , Gross
2013 Wages:
Paid:
Date March ___ , Gross
2013 Wages:
Paid:
Date March ___ , Gross
2013 Wages:
Paid:
Date March ___ , Gross
2013 Wages:
Paid:
Date March ___ , Gross
2013 Wages:
Paid:

BOX C

M

TOTAL
Gross Wages

$
$
$
$
$
$
$

,.
,.
,.
,.
,.
,.
,.


Use the TOTAL Gross Wages from BOX C when you report wages for
MARCH 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 April 2013
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
21
28

15
22
29

16
23
30

17
24

18
25

19
26

20
27

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

S

T

W

T

F

S

1

2

3

4

6

BOX B

Date April ___ , Gross
2013 Wages:
Paid:
Date April ___ , Gross
2013 Wages:
Paid:
Date April ___ , Gross
2013 Wages:
Paid:
Date April ___ , Gross
2013 Wages:
Paid:
Date April ___ , Gross
2013 Wages:
Paid:
Date April ___ , Gross
2013 Wages:
Paid:

BOX C

5

M

TOTAL
Gross Wages

$
$
$
$
$
$
$

,.
,.
,.
,.
,.
,.
,.


Use the TOTAL Gross Wages from BOX C when you report wages for
APRIL 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 May 2013
Wages for MAY
S

M

T

W

T

Days to report in JUNE
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 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

BOX B

Date May ___ , Gross
2013 Wages:
Paid:
Date May ___ , Gross
2013 Wages:
Paid:
Date May ___ , Gross
2013 Wages:
Paid:
Date May ___ , Gross
2013 Wages:
Paid:
Date May ___ , Gross
2013 Wages:
Paid:
Date May ___ , Gross
2013 Wages:
Paid:

BOX C

M

TOTAL
Gross Wages

$
$
$
$
$
$
$

,.
,.
,.
,.
,.
,.
,.


Use the TOTAL Gross Wages from BOX C when you report wages for
MAY 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 June 2013
Wages for JUNE
S

M

2
9
16
23
30

T

3
10
17
24

4
11
18
25

W
5
12
19
26

T
6
13
20
27

Days to report in JULY
F
7
14
21
28

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

BOX B

Date June ___ , Gross
2013 Wages:
Paid:
Date June ___ , Gross
2013 Wages:
Paid:
Date June ___ , Gross
2013 Wages:
Paid:
Date June ___ , Gross
2013 Wages:
Paid:
Date June ___ , Gross
2013 Wages:
Paid:
Date June ___ , Gross
2013 Wages:
Paid:

BOX C

S

TOTAL
Gross Wages

$
$
$
$
$
$
$

,.
,.
,.
,.
,.
,.
,.


Use the TOTAL Gross Wages from BOX C when you report wages for
JUNE 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 July 2013
Wages for JULY
S

M

T

W

T

Days to report in AUGUST
F

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

31

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

4

M

5

T

W

T

F

S

1

2

3

6

BOX B

Date July ___ , Gross
2013 Wages:
Paid:
Date July ___ , Gross
2013 Wages:
Paid:
Date July ___ , Gross
2013 Wages:
Paid:
Date July ___ , Gross
2013 Wages:
Paid:
Date July ___ , Gross
2013 Wages:
Paid:
Date July ___ , Gross
2013 Wages:
Paid:

BOX C

S

TOTAL
Gross Wages

$
$
$
$
$
$
$

,.
,.
,.
,.
,.
,.
,.


Use the TOTAL Gross Wages from BOX C when you report wages for
JULY 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 August 2013
Wages for AUGUST
S

M

T

W

T

Days to report in SEPTEMBER

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

M

T

W

T

F

1

2

3

4

5

6

S

BOX B

Date August ___ , Gross
2013 Wages:
Paid:
Date August ___ , Gross
2013 Wages:
Paid:
Date August ___ , Gross
2013 Wages:
Paid:
Date August ___ , Gross
2013 Wages:
Paid:
Date August ___ , Gross
2013 Wages:
Paid:
Date August ___ , Gross
2013 Wages:
Paid:

BOX C

S

TOTAL
Gross Wages

$
$
$
$
$
$
$

,.
,.
,.
,.
,.
,.
,.


Use the TOTAL Gross Wages from BOX C when you report wages for
AUGUST 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 September 2013
Wages for SEPTEMBER
S
1
8
15
22
29

M

T

2
9
16
23
30

3
10
17
24

W

T

4
11
18
25

5
12
19
26

F

Days to report in OCTOBER
S

6
13
20
27

S

7
14
21
28

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

BOX B

Date September ___ , Gross
2013 Wages:
Paid:
Date September ___ , Gross
2013 Wages:
Paid:
Date September ___ , Gross
2013 Wages:
Paid:
Date September ___ , Gross
2013 Wages:
Paid:
Date September ___ , Gross
2013 Wages:
Paid:
Date September ___ , Gross
2013 Wages:
Paid:

BOX C

M

TOTAL
Gross Wages

$
$
$
$
$
$
$

,.
,.
,.
,.
,.
,.
,.


Use the TOTAL Gross Wages from BOX C when you report wages for
September 2013
Call 1-866-772-0953 now and make your report
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS

Privacy Act Statement
Collection and Use of Personal Information
Sections 205a and 1631 of the Social Security Act (42 U.S.C. §§ 405a, 1383), as amended, and
Executive Order 9397, as amended, authorize us to collect this information, including your
Social Security number. We will use the information you provide us to determine eligibility for
Supplemental Security Income.
Furnishing us this information is voluntary. However, failing to provide us with all or part of the
information could prevent us from making an accurate and timely decision on Supplemental
Security Income benefits.
We rarely use the information you supply for any purpose other than for making a determination
relating to Supplemental Security Income benefits. However, we may use it for the
administration and integrity of Social Security programs. We may also disclose information to
another person or to another agency in accordance with approved routine uses, which include but
are not limited to the following:
1. To enable a third party or an agency to assist Social Security in establishing rights to
Social Security benefits and/or coverage;
2. To comply with Federal laws requiring the release of information from Social
Security records (e.g., to the Government Accountability Office and Department of
Veterans’ Affairs);
3. To make determinations for eligibility in similar health and income maintenance
programs at the Federal, State, and local level; and,
4. To facilitate statistical research, audit, or investigative activities necessary to assure
the integrity and improvement of Social Security programs (e.g., to the Bureau of the
Census and private entities under contract with us).
We may also use the information you provide in computer matching programs. Matching
programs compare our records with records kept by other Federal, State, or local government
agencies. Information from these matching programs can be used to establish or verify a person’s
eligibility for federally-funded or administered benefit programs and for repayment of payments
or delinquent debts under these programs.
A complete list of routine uses for this information is available in Systems of Records Notice
entitled, Supplemental Security Income Record, 60-0103. This notice, additional information,
and information regarding our programs and systems, are available on-line at
www.socialsecurity.gov or at your local Social Security office.

Mobile SSI Wage Reporting Screen Package
Screen Images and Interactions
Access Code Entry

SSIMWR

Page 1

July 2012

Mobile SSI Wage Reporting Screen Package
Terms of Service

Full Terms of Service wording:









I understand that this application contains U.S. Government information.
I consent to the monitoring of my use of this application to ensure its appropriate use.
I understand that it is a federal crime to:
·
Give false or misleading statements to obtain information in Social Security records; or
·
Deceive the Social Security Administration of an individual’s identity.
I understand that unauthorized use of, or access to, this application may subject me to criminal
or civil penalties, or both.
I understand that if I am submitting wages for someone else, I must have his or her permission
to do so.
I understand that Social Security may stop me from using this service if it finds or suspects
misuse.

SSIMWR

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Mobile SSI Wage Reporting Screen Package
Enter PII
1st Appearance of Screen
(Before Errors - Empty)

SSIMWR

2nd / 3rd Appearance of Screen
(After Errors - prepopulated)

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July 2012

Mobile SSI Wage Reporting Screen Package
Confirm PII
Standard Name Display

SSIMWR

With Other Last Name Displayed

Page 4

July 2012

Mobile SSI Wage Reporting Screen Package
Reporting Path Choice

SSIMWR

Page 5

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Mobile SSI Wage Reporting Screen Package
Wage Entry for Self

SSIMWR

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July 2012

Mobile SSI Wage Reporting Screen Package
Confirm Wage Report for Self

SSIMWR

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July 2012

Mobile SSI Wage Reporting Screen Package
SSN and Wage Entry for Other
1st Appearance of Screen
(Before Errors - Empty)

SSIMWR

2nd / 3rd Appearance of Screen
(After Errors - prepopulated)

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July 2012

Mobile SSI Wage Reporting Screen Package
Confirm Wage Report for Other

SSIMWR

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Mobile SSI Wage Reporting Screen Package
Interim Successful Submission

SSIMWR

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Mobile SSI Wage Reporting Screen Package
Final Successful Submission

SSIMWR

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July 2012

Mobile SSI Wage Reporting Screen Package
Log Out Confirmation

SSIMWR

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July 2012

Mobile SSI Wage Reporting Screen Package
Privacy Act Statement

Full Privacy Act Statement Wording:

Sections 205(a) and 1631 of the Social Security Act (42 U.S.C. §§ 405a, 1383), as amended, and
Executive Order 9397, as amended, authorize us to collect information needed for wage
reporting, including your Social Security number. We will use the information you provide us to
determine eligibility for Supplemental Security Income.
Furnishing us this information is voluntary. However, failing to provide us with all or part of the
information could prevent us from making an accurate and timely decision on Supplemental
Security Income benefits.
We rarely use the information you supply for any purpose other than for making a determination
relating to Supplemental Security Income benefits. However, we may use it for the
administration and integrity of Social Security programs. We also may disclose information to
another person or to another agency in accordance with approved routine uses, which include but
are not limited to the following:

SSIMWR

Page 13

July 2012

Mobile SSI Wage Reporting Screen Package
1. To enable a third party or an agency to assist Social Security in establishing rights to
Social Security benefits and/or coverage;
2. To comply with Federal laws requiring the release of information from Social
Security records (e.g., to the Government Accountability Office and Department of
Veterans’ Affairs);
3. To make determinations for eligibility in similar health and income maintenance
programs at the Federal, State, and local level; and,
4. To facilitate statistical research, audit, or investigative activities necessary to assure
the integrity and improvement of Social Security programs (e.g., to the Bureau of the
Census and private entities under contract to Social Security).
We may also use the information you provide in computer matching programs. Matching
programs compare our records with records kept by other Federal, State, or local government
agencies. We use information from these matching programs to establish or verify a person’s
eligibility for federally funded or administered benefit programs and for repayment of payments
or delinquent debts under these programs.
A complete list of routine uses for this information is available in Systems of Records Notice
below
for
entitled, Supplemental Security IncomeSee
Record,
60-0103.
This notice, additional information,
Privacy
and information regarding our programsrevised
and systems
areAct
available on-line at
www.socialsecurity.gov or at your localStatement
Social Security office.

SSIMWR

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July 2012

Mobile SSI Wage Reporting Screen Package
Paperwork Reduction Act

3

Full Paperwork Reduction Act Wording:
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
3
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.

SSIMWR

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Mobile SSI Wage Reporting Screen Package
Error Message Screens
Wage Reporting Period Closed

SSIMWR

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Mobile SSI Wage Reporting Screen Package
Service Unavailable

SSIMWR

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Mobile SSI Wage Reporting Screen Package
Cannot Connect

SSIMWR

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July 2012

Mobile SSI Wage Reporting Screen Package
Access Code Error: 1st and 2nd Strikes

SSIMWR

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July 2012

Mobile SSI Wage Reporting Screen Package
Access Code Error: 3rd Strike

SSIMWR

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July 2012

Mobile SSI Wage Reporting Screen Package
In-line Field Error (example)

SSIMWR

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July 2012

Mobile SSI Wage Reporting Screen Package
Verification/Exclusion Check Error: 1st and 2nd Strikes

SSIMWR

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July 2012

Mobile SSI Wage Reporting Screen Package
Verification/Exclusion Check Error: 3rd Strike

SSIMWR

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Mobile SSI Wage Reporting Screen Package
Terms of Service Refusal

SSIMWR

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Mobile SSI Wage Reporting Screen Package
Time Out Warning

SSIMWR

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July 2012

Mobile SSI Wage Reporting Screen Package
Time Out Error

SSIMWR

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Mobile SSI Wage Reporting Screen Package
Close This App Warning

SSIMWR

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July 2012

Privacy Act Statement
Collection and Use of Personal Information
Sections 205a and 1631 of the Social Security Act (42 U.S.C. §§ 405a, 1383), as amended, and
Executive Order 9397, as amended, authorize us to collect this information, including your
Social Security number. We will use the information you provide us to determine eligibility for
Supplemental Security Income.
Furnishing us this information is voluntary. However, failing to provide us with all or part of the
information could prevent us from making an accurate and timely decision on Supplemental
Security Income benefits.
We rarely use the information you supply for any purpose other than for making a determination
relating to Supplemental Security Income benefits. However, we may use it for the
administration and integrity of Social Security programs. We may also disclose information to
another person or to another agency in accordance with approved routine uses, which include but
are not limited to the following:
1. To enable a third party or an agency to assist Social Security in establishing rights to
Social Security benefits and/or coverage;
2. To comply with Federal laws requiring the release of information from Social
Security records (e.g., to the Government Accountability Office and Department of
Veterans’ Affairs);
3. To make determinations for eligibility in similar health and income maintenance
programs at the Federal, State, and local level; and,
4. To facilitate statistical research, audit, or investigative activities necessary to assure
the integrity and improvement of Social Security programs (e.g., to the Bureau of the
Census and private entities under contract with us).
We may also use the information you provide in computer matching programs. Matching
programs compare our records with records kept by other Federal, State, or local government
agencies. Information from these matching programs can be used to establish or verify a person’s
eligibility for federally-funded or administered benefit programs and for repayment of payments
or delinquent debts under these programs.
A complete list of routine uses for this information is available in Systems of Records Notice
entitled, Supplemental Security Income Record, 60-0103. This notice, additional information,
and information regarding our programs and systems, are available on-line at
www.socialsecurity.gov or at your local Social Security office.