Form Ssa-1383-Fc - Reporting To Social Security Administration By Student Outside The United States

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Form SSA-1383-FC (03-2017)
Page 1 of 2
Discontinue Prior Editions
Social Security Administration
OMB No. 0960-0088
REPORT TO SOCIAL SECURITY ADMINISTRATION
Our address is:
BY STUDENT OUTSIDE THE UNITED STATES
Social Security Administration
(Use this form ONLY when there is a change to be
P.O. Box 1756
reported for a United States Social Security beneficiary)
Baltimore, Maryland 21203 U.S.A.
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, C
, HC, HC
. Your report cannot be processed
1
1
without the correct claim number.
LETTER
If you need help in completing this form or additional information about your benefits, you may contact the nearest U.S.
Social Security office, Embassy or Consulate.
Please MAIL THIS REPORT DIRECTLY TO:
Social Security Administration
P.O. Box 1756
Baltimore, Maryland 21203 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)
Check if change is for:
More than 6 mos.
6 mos. or less
DATE EMPLOYMENT BEGAN
2.
EMPLOYMENT (As employee or as self-employed person)
DATE OF MARRIAGE
3.
MARRIAGE
4.
NO LONGER ATTENDING ANY SCHOOL (Do NOT report this item merely because school
MONTH, DAY, YEAR
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
MONTH, DAY, YEAR
5.
REDUCED SCHOOL ATTENDANCE TO LESS THAN FULL-TIME
The last day that I attended school on a full-time basis was
MONTH, DAY, YEAR
6a.
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
MONTH, YEAR
e.
DATE SCHOOL YEAR WILL END
MONTH, DAY, YEAR
7a.
STUDENT'S EMPLOYER IS PAYING STUDENT TO ATTEND SCHOOL
I began attending school as part of my job on
b.
NAME AND ADDRESS OF EMPLOYER

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