SSA-7162-OCR-SM--Report to U.S. SSA

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. since you last reported your marital status to SSA? If
not, Have you married or had a divorce or annulment 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) year the work ended. If not ended, write “not if the
work has ended, enter the month, day and 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.