Download:
pdf |
pdfForm Approved
OMB No. 0960-0778
Social Security Administration
Notification of a Social Security Number (SSN)
to an Employer for Wage Reporting Purposes
A.
Employer Information
Employer's Name:
Employer's Address:
Street:
City:
State:
Zip:
Employer's Identification Number (EIN):
B.
To be completed by the SSN applicant
I request that SSA notify my employer of my SSN
upon assignment.
Printed Name:
Signature:
Date:
(MM/DD/YYYY)
C.
For SSA use only
An SSN has been assigned and a Social Security card was mailed to the following person who
requested we notify you directly of the SSN.
First Name:
Middle Name:
Last Name:
Social Security Number:
NOTE: This notification may only be used for original SSN applications when SSA has not yet
assigned an SSN.
Form SSA-132 (05-2010)
1
Social Security Administration
Instructions for Completing Notification of a Social Security Number (SSN)
to an Employer for Wage Reporting Purposes Form
Please read these instructions carefully before completing this form:
When to Use
This Form
Use this form if you are applying for a Social Security
Number (SSN) and want SSA to notify your employer of the
SSN upon assignment.
How to Complete
This Form
Section A. Employer information
Fill in the employer name, mailing address, and
Employer Identification Number (EIN).
Section B. To be completed by the SSN applicant
Sign and date the form at the SSA office at the time
you apply for the original SSN.
Section C. For SSA use only
The SSA field office employee will complete the name
and SSN of the person who signed in Section B. upon
assignment of the original SSN.
.
.
.
PRIVACY ACT NOTICE
Collection and Use of Personal Information
Section 205(a) of the Social Security Act, as amended, authorizes us to collect the information requested on
this form. Completion of this form is voluntary. By signing this form, you authorize us to notify your
employer of your Social Security number (SSN), upon assignment, for the purpose of wage reporting.
Without your signature, we cannot complete your request to notify your employer of the assigned SSN. We
will not use this form for any other purpose.
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 2 minutes to read the instructions, gather the facts, and answer the questions. SEND
OR BRING THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. The office is
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-132 (05-2010)
2
File Type | application/pdf |
File Title | Notification of a Social Security Number (SSN) to an Employer for Wage Reporting Purposes |
Subject | Use this form to complete a notification of a social security number to an employer for wage reporting purposes. |
Author | SSA |
File Modified | 2012-05-18 |
File Created | 2010-04-30 |