Current SSA-16-INST

REPORTING RESPONSIBILITIES FOR DISABILITY INSURANCE BENEFITS
CHANGES TO BE REPORTED AND HOW TO REPORT
FAILURE TO REPORT MAY RESULT IN OVERPAYMENTS THAT MUST BE REPAID

}

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 dies or becomes unable to
handle benefits.

}

Custody Change - Report if a person for whom
you are filing or who is in your care dies,
leaves your care or custody, or changes
address.

}

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

}

You become entitled to a pension or annuity
based on your employment not covered by
Social Security, or if such pension or annuity
changes or stops.

}

You have an unsatisfied warrant for a violation of
probation or parole under Federal or State Law.

}

Change of Marital Status- Marriage, divorce, and
annulment of marriage. You must report marriage
even if you believe that an exception applies.

}

You return to work (as an employee or
self-employed) regardless of amount of earnings.

}

Your condition improves.

}

You are under age 65 and you apply for or begin
to receive workers' compensation (including
black lung benefits) or another public disability
benefit, or the amount of your present workers'
compensation or public disability benefit changes
or stops, or you receive a lump-sum settlement.

}

If you become the parent of a child (including an
adopted child) after you have filed your claim, let
us know about the child so we can decide if the
child is eligible for benefits. Failure to report the
existence of these children may result in the loss
of possible benefits to the child(ren).

HOW TO REPORT
You can make your reports online, 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:
} Visiting the section "What You Can Do Online" at our web site at www.socialsecurity.gov;
} 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.
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 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.

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

Form SSA-16-INST (11-2010) EF (11-2010)
Destroy prior editions

(OVER)

Collection and Use of Information From Your Application - Privacy Act Notice/Paperwork Reduction Act Notice

Sections 202, 205, and 223 of the Social Security Act, as amended, authorize us to collect this information. We will use the
information you provide to determine if you or a dependent are eligible for insurance coverage and/or monthly benefits.
The information you furnish on this form is voluntary. However, failure to provide the requested information may prevent us
from making an accurate and timely decision concerning your or a dependent's entitlement to benefit payments.
We rarely use the information you supply for any purpose other than for determining the identity of a spouse. 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, investigative, and audit activities necessary to assure the integrity of Social
Security programs.
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.
Additional information regarding this form, routine uses of information, and our programs and systems, is available on-line at
www.socialsecurity.gov or at your local Social Security office.

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
20 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 1-800-325-0778). 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.

Form SSA-16-INST (11-2010) EF (11-2010)