1. PHONE Social Security and explain the change.
Telephone Number ( )
2. VISIT Social Security
3. MAIL this form to Social Security. Make sure you fill in:
HOW TO REPORT
There are three ways to report:
NOTE: REMEMBER TO TELL US WHEN YOU MOVE,
EVEN IF YOUR MAILING ADDRESS FOR
CHECKS HAS NOT CHANGED.
If you do not report changes in your circumstances, 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.
If you hide or do not report a change with the intent to
fraudulently get more benefits or benefits not due you,
you may be fined, imprisoned, or both per Section 208 of
the Social Security Act.
FAILURE TO REPORT
The information you give on this form will be used to
determine if you are still eligible for Social Security
benefits and to make sure the amount of your benefit is
correct. Under certain limited conditions authorized by
law or regulation, Social Security may disclose this
information to another individual or government agency
in order to:
assist Social Security in establishing the right of an
individual to Social Security benefits and/or the
amount of the benefits;
facilitate statistical research and audit activities
necessary to assure the integrity and improvement of
the programs administered by Social Security; and
comply with Federal laws requiring the exchange of
information between Social Security and another
agency (such as the General Accounting Office and
the Veterans Administration).
We may also use the information you give us when we
match records by computer. Matching programs compare
our records with those of other Federal, State, and local
government agencies. Many agencies may use matching
programs to find or prove that a person qualifies for
benefits paid by the Federal government. The law allows
us to do this even if you do not agree to it.
Explanations about these and other reasons why
information you provide us may be used or given out are
available in Social Security offices. If you want to learn
more about this, contact any Social Security office.
Use this form only when there is a change to report to Social Security
Form SSA-1425 (04-2008) EF (08-2008)
·• NAME of person(s) the report is about
• The correct CLAIM NUMBER under which the
benefits are payable
• Whether the person(s) also receives SSI or Black
• WHAT is being reported
• DATE it happened
• Your SIGNATURE and ADDRESS
If you mail your report, please use this reporting form and send
it to the nearest Social Security office.
WHAT TO REPORT
The law Sections 202, 203, and 205 of the Social Security Act,
as amended (42 United States Code 402, 403, and 405.)
required you to promptly report certain changes in your
circumstances which could affect your continuing eligibility to
benefits or your benefit amount. The kinds of changes you
must report to Social Security are listed on the reverse side of
this form. The booklet, "Your Social Security Rights and
Responsibilities, "tells more about reporting changes. If you
do not have this booklet or if you want help in making a
report, get in touch with any Social Security office. The people
there will be glad to help you.
PAPERWORK REDUCTION ACT
Paperwork Reduction Act Statement - This information
collection meets the clearance 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. 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 onl
y comments relating to our
time estimate to this address, not the completed form.
See below for