Supplemental Security Income Mobile Wage Reporting (SSIMWR)

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 Google Play and the Apple App Store. 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
Please report wages during the first 6 days of the month to help prevent an
incorrect SSI payment. You can choose which of the 6 days to report. If you
miss reporting wages during the first 6 day reporting period at the beginning of the
month, you can still report the wages using the smartphone application or at your
local Social Security Office.
Things you need to have before you report wages by smartphone
 The user’s Social Security number (SSN). This is the person actually using
the smartphone application to report the wages;
 The Social Security number of the wage earner (this is the person working);
 The TOTAL amount of gross wages received by the wage earner. Gross
wages are the amount of pay before taxes and other deductions; and
 The reporter’s (user’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)
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 "Get." 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 Report Wages Using the Smartphone Application
1. If you are reporting wages for yourself or for another person, always enter your own
information on the first screen that asks for information even if you are not the
beneficiary, (this screen appears after the Reporting Month screen, titled “Tell Us
Who You Are”).
2. If you are reporting wages for yourself, enter and confirm your own gross wages.
(You already entered your SSN in the previous screen).
Note: If you are reporting wages as a parent or wage earner and your child receives
SSI, only enter your own information. You do not need to enter your child’s SSN.
Your SSN is connected to your child’s record, so therefore the report is posted
properly.
3. If you are reporting wages for “other persons,” you are to input the Social Security
number of the person who earned his/her wages in the “Enter SSN and Wages”
screen.
Note: Always enter wages of the wage earner, not the beneficiary. If you are a parent
reporting wages, but your spouse is the wage earner, you will enter your spouse’s SSN
and gross wages earned.
4. If you are reporting wages for yourself and another person, enter your own
information first and after a successful submission, you will see a “Submit More
Wages” button. Select this button to begin to submit wages for the other person. Enter
their SSN and their wages; there is no need to enter your own information again.

How to Fill-in the Worksheet
Date Paid
Use Box A to show the date paid (pay day).
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 and timely monthly wage reporting helps prevent SSI overpayments
and underpayments.

Wage Reporting Reminder
You can now sign up for email or text reminders to report monthly wages for SSI at
www.socialsecurity.gov/ssiwagereporting.

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 and the associated instructions package is 0960-0715;
expiration date 08/31/2019.

OMB 0960-0715

Supplemental Security Income
Wages for October 2018
Wages for OCTOBER

Days to report in NOVEMBER

Su

Mo
1

Tu
2

We
3

Th
4

Fr
5

Sa
6

Su

Mo

Tu

We

Th
1

Fr
2

Sa
3

7
14

8
15

9
16

10
17

11
18

12
19

13
20

4
11

5
12

6
13

7
14

8
15

9
16

10
17

21

22

23

24

25

26

27

18

19

20

21

22

23

24

28

29

30

31

25

26

27

28

29

30

Please report October’s wages during the first 6 days of November.

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

Date
Paid:

BOX B
___,
2018

Gross
Wages:

$,.
Date
___, Gross
Paid: October
2018 Wages: $,.
Date
___, Gross
Paid: October
2018 Wages: $,.
Date
___, Gross
Paid: October
2018 Wages: $,.
Date
___, Gross
Paid: October
2018 Wages: $,.
Date
___, Gross
Paid: October
2018 Wages: $,.
TOTAL
Box C
$,.
Gross
October

Wages

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

October 2018
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS

OMB 0960-0715

Supplemental Security Income
Wages for November 2018
Wages for NOVEMBER

Days to report in DECEMBER

Su

Mo

Tu

We

Th
1

Fr
2

Sa
3

Su

Mo

Tu

We

Th

Fr

Sa
1

4
11

5
12

6
13

7
14

8
15

9
16

10
17

2
9

3
10

4
11

5
12

6
13

7
14

8
15

18

19

20

21

22

23

24

16

17

18

19

20

21

22

25

26

27

28

29

30

23

24

25

26

27

28

29

30

31

Please report November’s wages during the first 6 days of December.

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

Date
Paid:

BOX B
___,
2018

Gross
Wages:

$,.
Date
___, Gross
Paid: November 2018 Wages:
$,.
Date
___, Gross
Paid: November 2018 Wages:
$,.
Date
___, Gross
Paid: November 2018 Wages:
$,.
Date
___, Gross
Paid: November 2018 Wages:
$,.
Date
___, Gross
Paid: November 2018 Wages:
$,.
TOTAL
Box C
Gross Wages $,.
November

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

November 2018
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS

OMB 0960-0715

Supplemental Security Income
Wages for December 2018
Wages for DECEMBER

Days to report in JANUARY

Su

Mo

Tu

We

Th

Fr

Sa
1

Su

Mo

Tu
1

We
2

Th
3

Fr
4

Sa
5

2
9

3
10

4
11

5
12

6
13

7
14

8
15

6
13

7
14

8
15

9
16

10
17

11
18

12
19

16

17

18

19

20

21

22

20

21

22

23

24

25

26

23

24

25

26

27

28

29

27

28

29

30

31

30

31
Please report December’s wages during the first 6 days of January.

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

Date
Paid:

BOX B
___,
2018

Gross
Wages:

$,.
Date
___, Gross
Paid: December 2018 Wages:
$,.
Date
___, Gross
Paid: December 2018 Wages:
$,.
Date
___, Gross
Paid: December 2018 Wages:
$,.
Date
___, Gross
Paid: December 2018 Wages:
$,.
Date
___, Gross
Paid: December 2018 Wages:
$,.
TOTAL
Box C
Gross Wages $,.
December

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

December 2018
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS

OMB 0960-0715

Supplemental Security Income
Wages for January 2019
Wages for JANUARY

Days to report in FEBRUARY

Su

Mo

Tu
1

We
2

Th
3

Fr
4

Sa
5

Su

Mo

Tu

We

Th

Fr
1

Sa
2

6
13

7
14

8
15

9
16

10
17

11
18

12
19

3
10

4
11

5
12

6
13

7
14

8
15

9
16

20

21

22

23

24

25

26

17

18

19

20

21

22

23

27

28

29

30

31

24

25

26

27

28

Please report January’s wages during the first 6 days of February.

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

Date
Paid:

BOX B
___,
2019

Gross
Wages:

$,.
___, Gross
Date
Paid: January
2019 Wages:
$,.
Date
___, Gross
Paid: January
2019 Wages:
$,.
Date
___, Gross
Paid: January
2019 Wages:
$,.
Date
___, Gross
Paid: January
2019 Wages:
$,.
Date
___, Gross
Paid: January
2019 Wages:
$,.
TOTAL
Box C
Gross Wages $,.
January

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

January 2019
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS

OMB 0960-0715

Supplemental Security Income
Wages for February 2019
Wages for FEBRUARY

Days to report in MARCH

Su

Mo

Tu

We

Th

Fr
1

Sa
2

Su

Mo

Tu

We

Th

Fr
1

Sa
2

3
10

4
11

5
12

6
13

7
14

8
15

9
16

3
10

4
11

5
12

6
13

7
14

8
15

9
16

17

18

19

20

21

22

23

17

18

19

20

21

22

23

24

25

26

27

28

24

25

26

27

28

29

30

31
Please report February’s wages during the first 6 days of March.

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

Date
Paid:

BOX B
___,
2019

Gross
Wages:

$,.
___, Gross
Date
Paid: February
2019 Wages:
$,.
Date
___, Gross
Paid: February
2019 Wages:
$,.
Date
___, Gross
Paid: February
2019 Wages:
$,.
Date
___, Gross
Paid: February
2019 Wages:
$,.
Date
___, Gross
Paid: February
2019 Wages:
$,.
TOTAL
Box C
Gross Wages $,.
February

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

February 2019
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS

OMB 0960-0715

Supplemental Security Income
Wages for March 2019
Wages for MARCH
Su

Mo

Tu

We

Th

Days to report in APRIL
Fr
1

Sa
2

Su

Mo

Tu

We

Th

Fr

Sa

1

2

3

4

5

6

3
10

4
11

5
12

6
13

7
14

8
15

9
16

7
14

8
15

9
16

10
17

11
18

12
19

13
20

17

18

19

20

21

22

23

21

22

23

24

25

26

27

24

25

26

27

28

29

30

28

29

30

31
Please report March’s wages during the first 6 days of April.

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

Date
Paid:

BOX B
___,
2019

Gross
Wages:

$,.
Date
___, Gross
Paid: March
2019 Wages:
$,.
Date
___, Gross
Paid: March
2019 Wages:
$,.
Date
___, Gross
Paid: March
2019 Wages:
$,.
Date
___, Gross
Paid: March
2019 Wages:
$,.
Date
___, Gross
Paid: March
2019 Wages:
$,.
TOTAL
Box C
Gross Wages $,.
March

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

March 2019
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS

OMB 0960-0715

Supplemental Security Income
Wages for April 2019
Wages for APRIL

Days to report in MAY

Su

Mo
1

Tu
2

We
3

Th
4

Fr
5

Sa
6

Su

Mo

Tu

We
1

Th
2

Fr
3

Sa
4

7
14

8
15

9
16

10
17

11
18

12
19

13
20

5
12

6
13

7
14

8
15

9
16

10
17

11
18

21

22

23

24

25

26

27

19

20

21

22

23

24

25

28

29

30

26

27

28

29

30

31

Please report April’s wages during the first 6 days of May.

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

BOX B
___,
2019

Gross
Wages:

$,.
___, Gross
2019 Wages:
$,.
___, Gross
2019 Wages:
$,.
___, Gross
2019 Wages:
$,.
___, Gross
2019 Wages:
$,.
___, Gross
2019 Wages:
$,.
TOTAL
Gross Wages $,.

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

April 2019
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS

OMB 0960-0715

Supplemental Security Income
Wages for May 2019
Wages for MAY
Su

Mo

Tu

5

6

12

Days to report in JUNE

Th
2
9

Fr
3
10

Sa
4
11

Su

Mo

Tu

We

Th

Fr

7

We
1
8

2

3

4

5

6

7

Sa
1
8

13

14

15

16

17

18

9

10

11

12

13

14

15

19

20

21

22

23

24

25

16

17

18

19

20

21

22

26

27

28

29

30

31

23

24

25

26

27

28

29

30
Please report May’s wages during the first 6 days of June.

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

BOX B
___,
2019

Gross
Wages:

$,.
___, Gross
2019 Wages:
$,.
___, Gross
2019 Wages:
$,.
___, Gross
2019 Wages:
$,.
___, Gross
2019 Wages:
$,.
___, Gross
2019 Wages:
$,.
TOTAL
Gross Wages $,.

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

May 2019
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS

OMB 0960-0715

Supplemental Security Income
Wages for June 2019
Wages for JUNE

Days to report in JULY

Su

Mo

Tu

We

Th

Fr

Sa
1

Su

Mo
1

Tu
2

We
3

Th
4

Fr
5

Sa
6

2
9

3
10

4
11

5
12

6
13

7
14

8
15

7
14

8
15

9
16

10
17

11
18

12
19

13
20

16

17

18

19

20

21

22

21

22

23

24

25

26

27

23

24

25

26

27

28

29

28

29

30

31

30
Please report June’s wages during the first 6 days of July.

BOX A
Line
1

Date
Paid:

June

Line
2

Date
Paid:

June

Line
3

Date
Paid:

June

Line
4

Date
Paid:

June

Line
5

Date
Paid:

June

Line
6

Date
Paid:

June

Box C

BOX B
___,
2019

Gross
Wages:

$,.
___, Gross
2019 Wages:
$,.
___, Gross
2019 Wages:
$,.
___, Gross
2019 Wages:
$,.
___, Gross
2019 Wages:
$,.
___, Gross
2019 Wages:
$,.
TOTAL
Gross Wages $,.

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

June 2019
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS

OMB 0960-0715

Supplemental Security Income
Wages for July 2019
Wages for JULY

Days to report in AUGUST

Su

Mo
1

Tu
2

We
3

Th
4

Fr
5

Sa
6

Su

Mo

Tu

We

Th
1

Fr
2

Sa
3

7
14

8
15

9
16

10
17

11
18

12
19

13
20

4
11

5
12

6
13

7
14

8
15

9
16

10
17

21

22

23

24

25

26

27

18

19

20

21

22

23

24

28

29

30

31

25

26

27

28

29

30

31

Please report July’s wages during the first 6 days of August.

BOX A
Line
1

Date
Paid:

July

Line
2

Date
Paid:

July

Line
3

Date
Paid:

July

Line
4

Date
Paid:

July

Line
5

Date
Paid:

July

Line
6

Date
Paid:

July

Box C

BOX B
___,
2019

Gross
Wages:

$,.
___, Gross
2019 Wages:
$,.
___, Gross
2019 Wages:
$,.
___, Gross
2019 Wages:
$,.
___, Gross
2019 Wages:
$,.
___, Gross
2019 Wages:
$,.
TOTAL
Gross Wages $,.

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

July 2019
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS

OMB 0960-0715

Supplemental Security Income
Wages for August 2019
Wages for AUGUST

Days to report in SEPTEMBER

Su

Mo

Tu

We

Th
1

Fr
2

Sa
3

Su
1

Mo
2

Tu
3

We
4

Th
5

Fr
6

Sa
7

4
11

5
12

6
13

7
14

8
15

9
16

10
17

8
15

9
16

10
17

11
18

12
19

13
20

14
21

18

19

20

21

22

23

24

22

23

24

25

26

27

28

25

26

27

28

29

30

31

29

30

Please report August’s wages during the first 6 days of September.

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

Date
Paid:

BOX B
___,
2019

Gross
Wages:

$,.
Date
___, Gross
Paid: August
2019 Wages:
$,.
Date
___, Gross
Paid: August
2019 Wages:
$,.
Date
___, Gross
Paid: August
2019 Wages:
$,.
Date
___, Gross
Paid: August
2019 Wages:
$,.
Date
___, Gross
Paid: August
2019 Wages:
$,.
TOTAL
Box C
Gross Wages $,.
August

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

August 2019
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS

OMB 0960-0715

Supplemental Security Income
Wages for September 2019
Wages for SEPTEMBER

Days to report in OCTOBER

Su
1

Mo
2

Tu
3

We
4

Th
5

Fr
6

Sa
7

Su

Mo

Tu
1

We
2

Th
3

Fr
4

Sa
5

8
15

9
16

10
17

11
18

12
19

13
20

14
21

6
13

7
14

8
15

9
16

10
17

11
18

12
19

22

23

24

25

26

27

28

20

21

22

23

24

25

26

29

30

27

28

29

30

31

Please report September’s wages during the first 6 days of October.

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

Date
Paid:

BOX B
___,
2019

Gross
Wages:

$,.
Date
___, Gross
Paid: September 2019 Wages:
$,.
Date
___, Gross
Paid: September 2019 Wages:
$,.
Date
___, Gross
Paid: September 2019 Wages:
$,.
Date
___, Gross
Paid: September 2019 Wages:
$,.
Date
___, Gross
Paid: September 2019 Wages:
$,.
TOTAL
Box C
Gross Wages $,.
September

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

September 2019
KEEP PAY SLIPS AND THIS FORM FOR YOUR RECORDS

SSA will insert the following revised Privacy Act Statement into the form as soon
as possible:
Privacy Act Statement
Collection and Use of Personal Information
Sections 205(a) and 1631(d) of the Social Security Act, as amended, allow us to collect this
information. Furnishing us this information is voluntary. However, failing to provide all or part
of the information may prevent us from making an accurate and timely decision on eligibility for
Supplemental Security Income (SSI) benefits.
We will use the information you provide to make a determination of eligibility for SSI benefits.
We may also share your information for the following purposes, called routine uses:


To third party contacts such as private collection agencies and credit reporting agencies
under contract with the Social Security Administration (SSA) and State motor vehicle
agencies for the purpose of their assisting SSA in recovering overpayments; and



To contractors and other Federal agencies, as necessary, for the purpose of assisting SSA
in the efficient administration of its programs.

In addition, we may share this information in accordance with the Privacy Act and other Federal
laws. For example, where authorized, we may use and disclose this information in computer
matching programs, in which our records are compared with other records to establish or verify a
person’s eligibility for Federal benefit programs and for repayment of incorrect or delinquent
debts under these programs.
A list of additional routine uses is available in our Privacy Act System of Records Notices
(SORN) 60-0089, entitled Claims Folders System, as published in the Federal Register (FR) on
April 01, 2003, at 68 FR 15784 and 60-0103, entitled Supplemental Security Income Record and
Special Veterans Benefits, as published in the FR on January 11, 2006, at 71 FR 1830.
Additional information, and a full listing of all of our SORNs, is available on our website at
www.ssa.gov/privacy.