Ssa-9781

Social Security Administration

Retirement, Survivors and Disability Insurance
Important Information

SOCIAL SECURITY ADMINISTRATION
PO BOX 9781
WILKES-BARRE PA 18767-9781
Date: November 14, 2013
Claim Number: 123-45-6789 A

SS9781ER-0000001 T-00001
SAMPLE A SAMPLE
SAMPLE BUILDING
2ND FLOOR
APT ABC
123 ANY ST
ANYTOWN, US 12345-6789
DDDAFTDDDTFDAFTFATTAFAAAFDADTADFFFDDDDADFAAAADTTDTADTADAATFTDDADF

We need updated information about your work to make sure that we pay you the
right amount of Social Security benefits. Earlier, you told us that your earnings this
year would be about $35,000 We want to review your estimate since your plans may
have changed. We also need to know about your work plans for 2015
What You Need To Do
Please complete the enclosed form to tell us about your work. Please return it as soon as
possible in the enclosed envelope.
Thank you for taking the time to complete the form. We may contact you again if we need
more information to process this form.
If You Have Questions
If you have any questions, please:
· Visit our website at www.socialsecurity.gov to find general information about Social
Security.
· Call us toll-free at 1-800-772-1213 or call your local office at
. We can answer
most questions over the phone. If you are deaf or hard of hearing, our toll-free TTY
number is 1-800-325-0778.
· Write or visit any Social Security office. If you plan to visit an office, you may
call ahead to make an appointment. The office that serves your area is located
at:
[FO ADDRESS1]
[FO ADDRESS2]
[FO ADDRESS3]
[FO ADDRESS4]
[FO CITY STATE ZIP]
.

.

[phone]

(OVER)
Form SSA-L9781-SM (7-2014)

Please have this letter with you if you call or visit an office. If you write, please include a
copy of the first page of this letter. It will help us answer your questions.
Sincerely,
Carolyn W. Colvin
Acting Commissioner of
Social Security
Enclosures:
Earnings Estimate Form SSA-L9781-SM
Envelope

SAMPLE A SAMPLE

123-45-6789 A

SAMPLE A SAMPLE

123-45-6789 A

• You will reach full retirement age in SEPTEMBER 2017.

SAMPLE A SAMPLE

123-45-6789 A
10/13 09/17
TOE 220 861006 P2

you told us you will earn $35,000 this year.
1. Earlier,
How much do you now think you will earn in 2014?

123-45-6789

OCTOBER NOVEMBER DECEMBER

SAMPLE A SAMPLE

123-45-6789 A