SSA-1383-FC Current Version

Form SSA-1383-FC (06-2018)
Discontinue Prior Editions
Social Security Administration

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OMB No. 0960-0088
Our address is:
Social Security Administration
P.O. Box 17769
Baltimore, MD 21235-7769 U.S.A.

REPORT TO SOCIAL SECURITY ADMINISTRATION
BY STUDENT OUTSIDE THE UNITED STATES
(Use this form ONLY when there is a change to be
reported for a United States Social Security beneficiary)

PRINT NAME OF STUDENT ABOUT WHOM REPORT IS MADE SOCIAL SECURITY CLAIM NUMBER ON WHICH
BENEFITS ARE PAID. It is a nine digit number
(000-00-0000) followed by a letter or a number, such as
C, C1, HC, HC1. Your report cannot be processed
without the correct claim number.

If you need help in completing this form or additional information about your benefits, you may contact your Federal
Benefits Units. For a list of Federal Benefits Units, visit www.socialsecurity.gov/foreign/foreign.htm.
Please MAIL THIS REPORT DIRECTLY TO:

Social Security Administration
P.O. Box 17769
Baltimore, Maryland 21235-7769 U.S.A.

Be sure to affix proper postage on the envelope.
CHECK OR FILL IN ONLY THE INFORMATION BEING REPORTED
1.

CHANGE OF ADDRESS (Print new address after signature below)
More than 6 months
6 months or less
Check if change is for:

2.

EMPLOYMENT (As employee or as self-employed person)

DATE EMPLOYMENT BEGAN

3.

MARRIAGE

DATE OF MARRIAGE

4.

NO LONGER ATTENDING ANY SCHOOL (Do NOT report this item merely because school MM/DD/YYYY
year ended if you intend to resume full-time attendance after a vacation period of not more
than 4 full calendar months.) The last day that I attended school on full-time basis was
MM/DD/YYYY
REDUCED SCHOOL ATTENDANCE TO LESS THAN FULL-TIME
The last day that I attended school on a full-time basis was

5.
6a.

MM/DD/YYYY

CHANGED SCHOOLS
I have arranged to change schools effective
I am (will be) attending
full-time
part-time

b.

NAME AND ADDRESS OF NEW SCHOOL (Give sufficient information for location of your records, such as type of
school, branch or campus and division)

c.

TYPE OF SCHOOL
ELEMENTARY or SECONDARY SCHOOL

UNIVERSITY

OTHER (explain)

d.

STUDENT IDENTIFICATION NUMBER

STUDENT'S SOCIAL SECURITY NUMBER

e.

DATE SCHOOL YEAR WILL END

MONTH, YEAR

7a.
b.

STUDENT'S EMPLOYER IS PAYING STUDENT TO ATTEND SCHOOL
I began attending school as part of my job on
NAME AND ADDRESS OF EMPLOYER

MM/DD/YYYY

Form SSA-1383-FC (06-2018)
8.

9.

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DATE OF INCARCERATION
INCARCERATION FOR CONVICTION OF A FELONY
Student is confined in a jail, prison, or other institution or correctional facility, based (MM/DD/YYYY)
on a conviction for a felony committed after October 19, 1980.
DATE OF ARREST WARRANT
WARRANT ISSUED FOR STUDENT'S ARREST
(MM/DD/YYYY)
Do you have an unsatisfied warrant for your arrest for a crime or attempted crime
of flight to avoid prosecution or confinement or escape from custody?

SIGNATURE OF PERSON MAKING THIS REPORT

DATE SIGNED

MAILING ADDRESS (NUMBER AND STREET, APT. NO.)

CITY OR TOWNSHIP

POSTAL CODE

COUNTRY

Notice: This report is authorized in order to confirm continuing eligibility to Social Security benefits as provided by law
(section 202(d) of the U.S. Social Security Act, as amended (42 United States code 402(d)).
WHAT TO REPORT
The kinds of events that you must report to Social Security are listed below. Check any of the events that apply to you and
fill in any other information requested about the event.
FAILURE TO REPORT
If you do not report events as shown on this form, you may not be paid some or all of the benefits due you, or you may be
overpaid, in which case, you will have to pay back any benefits you received that were not due you.
Also, if you conceal or fail to disclose a report event with an intent to fraudulently obtain benefits either in a greater amount
than is due or when no payment is authorized, you may be FINED, IMPRISONED, or both, as provided in section 208 of
the Social Security Act.
OTHER USES WHICH MAY BE MADE OF THE INFORMATION ON THIS REPORT
Privacy Act Statement
Collection and Use of Personal Information
Sections 202(d), 203 (h), and 205(a) 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 an accurate and
timely decision on any claim filed.
We will use the information to determine your entitlement and benefits. We may also share your information for the
following purposes, called routine uses:
1. To applicants, claimants, prospective applicants or claimants, other than the data subject, their authorized representative
payees to the extent necessary to pursue Social Security claims and to representative payees when the information
pertains to individuals for whom they serve as representative payees, for the purpose of assisting SSA in administering its
representative payment responsibilities under the Act and assisting the representative payees in performing their duties as
payees, including receiving and accounting for benefits for individuals for whom they serve as payees; and
2. To the Department of State and its agents for administering the Act in foreign countries through facilities and services of
that agency.
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 Notice (SORN) 60-0089 entitled Claims
Folders System. Additional information and a full listing of all our SORNs are available on our
website at www.socialsecurity.gov/foia/bluebook.
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 (OMB) control number. We estimate that it will take about 6 minutes to
read the instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate
above to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401.