Form SSA-7162-INSTRUCTIONS

INSTRUCTIONS FOR COMPLETION OF FORM SSA-7162-OCR-SM
WHAT YOU NEED TO DO
First, please read the instructions below. This is important
because not all questions are self-explanatory. Then,
complete your report and return it to the Social Security
Administration, P.O. Box 7162, Wilkes-Barre,
Pennsylvania, 18767-7162, U.S.A. in the enclosed envelope within 60 days from the day you receive it. If you do
not return it promptly, we may stop sending checks to you.
GENERAL INSTRUCTIONS
To help us process your report and avoid having to recontact you, please follow these instructions.
•

Use black ink or a dark pencil to complete the report.

•

Please print your answers, except in the signature
block.

•

Place “X’s” in the appropriate “Yes” or “No” boxes on
the first page.

•

On the first page, keep your “X’s” inside the boxes.

•

You must sign the form on the back page.

HOW TO FILL OUT THE FORM
The numbers below match the numbered questions on
the report.
Item 1. Do not write in this space if the preprinted
address in the box is correct. If the preprinted address is
incorrect and you have not reported your new address to
the Social Security Administration, then print the correct
address in this space.
Item 2. Enter the telephone number at which you may be
contacted during the day in this space.
Item 3. Has there been a change in your citizenship or
your country of residence that you have not yet reported to
SSA? If not, place an “X” in the “NO” box and go on to
item 4. If yes, place an “X” in the “YES” box and turn the
form over. In item 3 on the back, enter in:
(a) the country of new citizenship and the date the new
citizenship was acquired; and/or
(b) the current country of residence and the date the
residence began.
Item 4. Have you married or had a divorce or annulment
since you last reported your marital status to SSA? If not,
place an “X” in the “NO” box and go on to item 5. If yes,
place an “X” in the “YES” box and turn the form over. In
Item 4 on the back, enter in:
(a), (b) or (c) a check mark next to the event which
occurred; (d) the date the event occurred.

Form SSA-7162-INST (03-2004)
Destroy Prior Editions

Item 5. Did you work for someone else or own a business
or farm since your last report of work to SSA? If not, place
an “X” in the “NO” box and go on to item 6.
If yes, place an “X” in the “YES” box and turn the form
over. In item 5 on the back, enter in:
(a) a check mark in the first block if you worked for
someone else, or a check mark in the second block
if you were self-employed;
(b) the month, day and year the work began;
(c) if the work has ended, enter the month, day and
year the work ended. If not ended, write “not
ended”;
(d) list each month in the work period indicated in (b)
and (c) above that you worked 45 hours or less.
(Explain in “Remarks” why your employment/selfemployment calls for 45 hours or less);
(e) if the work was done in the U.S. or if U.S. Social
Security taxes (FICA) were paid on earnings from
this work, check the “Yes,” block. If not, check the
“No” block.
(f) if the answer in (e) above was “Yes,” enter your total
earnings for the year before last in the first space,
your earnings for last year in the second space, and
give an estimate of this year’s earnings in the last
space.
Item 6. Did you and the child live apart since you last
reported the child’s living arrangements to SSA? If not,
place an “X” in the “NO” box. If yes, place an “X” in the
“YES” box and turn the form over. In item 6 on the back,
enter in:
(a) the date the child left;
(b) the date the child returned. If the child has not
returned, enter “Not returned”;
(c) the name of the child who did not live with you;
(d) the reason for leaving;
(e) if the child has not returned, the address where the
child can be reached.
BE SURE TO TURN THE FORM OVER AND ENTER
YOUR SIGNATURE (OR MARK) AND THE DATE IN
ITEM 7. IF YOU SIGN WITH A MARK, A WITNESS
MUST COMPLETE ITEM 8. IF A WITNESS SIGNS THE
FORM, HE/SHE SHOULD ENTER HIS/HER NAME,
ADDRESS, AND THE DATE IN ITEM 8.
ALL KINDS OF WORK SHOULD BE REPORTED
Every kind of work, trade, apprenticeship or business in
which you engage while you are under age 66 MUST BE
REPORTED. After you notify us of work, we will inform
you if the work has any effect on benefits.