Form SSA-4-INST (01-2017) UF
Discontinue Prior Editions
Social Security Administration
REPORTING RESPONSIBILITIES FOR CHILD'S INSURANCE BENEFITS
Page 1 of 2
OMB No. 0960-0010
CHANGES TO BE REPORTED AND HOW TO REPORT
FAILURE TO REPORT MAY RESULT IN OVERPAYMENTS THAT MUST BE REPAID AND IN
POSSIBLE MONETARY PENALTIES
•
You or any child changes the mailing address for checks
or residence. To avoid delay in receipt of checks you
should ALSO file a regular change of address notice with
your post office.
•
Any child's citizenship or immigration status changes.
•
Any beneficiary goes outside the U.S.A. for 30
consecutive days or longer.
•
Any beneficiary dies or becomes unable to handle
benefits.
•
Work Changes - On your application you told us
(Name of Child)
expected total earnings
for
(Year)
to be $
.
(Name of Child)
(is) (is not) earning
wages of more than $ a month.
(Name of Child)
(is) (is not) self-
employed and rendering substantial services in a trade
or business.
(Report AT ONCE if this work pattern changes)
•
Custody Change - Report if a child for whom you are
filing, or who is in your care dies, leaves your care or
custody, or changes address.
•
The child age 13 or older has an unsatisfied felony or
arrest warrant for more than 30 continuous days for flight
to avoid prosecution or confinement, escape from
custody, or flight-escape.
•
A student, age 18 or over, stops attending school,
reduces school attendance below full-time, changes
schools, or is paid by an employer to attend school.
•
If the worker and stepchild's parent divorce. Benefits are
not payable to a stepchild beginning with the month after
the month the worker and the stepchild's parent divorce.
Promptly return any benefit payment received on behalf of
the stepchild for the months after the month the divorce
becomes final.
•
Change in Marital Status - Marriage, divorce, or
annulment of marriage. You must report marriage even if
you believe that an exception applies.
•
Disability Applicants - In addition to the applicable
reporting requirements listed above:
1. The disabled adult child returns to work (as an
employee or self-employed) regardless of
amount of earnings.
2. The disabled adult child's condition improves.
An agency in your State that works with us in administering
the Social Security disability program is responsible for
making the disability decision on the child's claim. In some
cases, it is necessary for them to get additional information
about the child's condition or to arrange for the child to have
a medical examination at Government expense.
HOW TO REPORT
You can make your reports by telephone, mail, or in person,
whichever you prefer.
If you are awarded benefits, and one or more of the above
change(s) occur, you should report by:
•
Visiting the section "What You Can Do Online" at
our web site at www.socialsecurity.gov;
•
Calling us TOLL FREE at 1-800-772-1213;
•
If you are deaf or hearing impaired, calling us TOLL
FREE at TTY 1-800-325-0778; or
•
Calling, visiting or writing your local Social Security
office at the phone number and
address above.
For general information about Social Security, visit our web
site at www.socialsecurity.gov.
For those under full retirement age, the law requires that a
report of earnings be filed with SSA within 3 months and 15
days after the end of any taxable year in which the child
earns more than the annual exempt amount. You may
contact SSA to file a report for the child. Otherwise, SSA
will use the earnings reported by the child's employer(s)
and the child's self-employment tax return (if applicable) as
the report of earnings required by law, to adjust benefits
under the earnings test. It is your responsibility to ensure
that the information you give concerning the child's earnings
is correct.
The child is confined for more than 30 continuous days to
a jail, prison, penal institution or correctional facility for
conviction of a crime or confined to a public institution by
a court order in connection with a crime.
•
