Reporting Changes That Affect Your Social Security Payment Page 2

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HOW TO REPORT
CONFIDENTIAL INFORMATION
The information you give on this form will be used to
There are three ways to report:
determine if you are still eligible for Social Security
1. PHONE Social Security and explain the change.
benefits and to make sure the amount of your benefit is
correct. Under certain limited conditions authorized by
Telephone Number (
)
law or regulation, Social Security may disclose this
(Area Code)
information to another individual or government agency
2. VISIT Social Security
in order to:
3. MAIL this form to Social Security. Make sure you fill in:
assist Social Security in establishing the right of an
individual to Social Security benefits and/or the
·• NAME of person(s) the report is about
amount of the benefits;
The correct CLAIM NUMBER under which the
facilitate statistical research and audit activities
benefits are payable
necessary to assure the integrity and improvement of
the programs administered by Social Security; and
• Whether the person(s) also receives SSI or Black
Lung benefits.
comply with Federal laws requiring the exchange of
information between Social Security and another
• WHAT is being reported
agency (such as the General Accounting Office and
the Veterans Administration).
• DATE it happened
We may also use the information you give us when we
• Your SIGNATURE and ADDRESS
match records by computer. Matching programs compare
our records with those of other Federal, State, and local
If you mail your report, please use this reporting form and send
government agencies. Many agencies may use matching
it to the nearest Social Security office.
programs to find or prove that a person qualifies for
benefits paid by the Federal government. The law allows
NOTE:
REMEMBER TO TELL US WHEN YOU MOVE,
us to do this even if you do not agree to it.
EVEN IF YOUR MAILING ADDRESS FOR
CHECKS HAS NOT CHANGED.
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
WHAT TO REPORT
more about this, contact any Social Security office.
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
PAPERWORK REDUCTION ACT
benefits or your benefit amount. The kinds of changes you
must report to Social Security are listed on the reverse side of
Paperwork Reduction Act Statement - This information
this form. The booklet, "Your Social Security Rights and
collection meets the clearance requirements of 44 U.S.C.
Responsibilities, "tells more about reporting changes. If you
§3507, as amended by Section 2 of the Paperwork
do not have this booklet or if you want help in making a
Reduction Act of 1995. You do not need to answer these
report, get in touch with any Social Security office. The people
questions unless we display a valid Office of Management
there will be glad to help you.
and Budget control number. We estimate that it will take
about 5 minutes to read the instructions, gather the facts,
SEND OR BRING THE
and answer the questions.
FAILURE TO REPORT
COMPLETED FORM TO YOUR LOCAL SOCIAL
SECURITY OFFICE. The office is listed under U.S.
If you do not report changes in your circumstances, you
Government agencies in your telephone directory or you
may not be paid some, or all, of the benefits due you. Or,
may call Social Security at 1-800-772-1213 (TTY
you may be overpaid, in which case, you will have to pay
1-800-325-0778). You may send comments on our time
back any benefits you received that were not due you.
estimate above to: SSA, 6401 Security Blvd., Baltimore,
MD 21235-6401. Send only comments relating to our
If you hide or do not report a change with the intent to
time estimate to this address, not the completed form.
fraudulently get more benefits or benefits not due you,
you may be fined, imprisoned, or both per Section 208 of
the Social Security Act.
See below for
revised Paperwork
Reduction Act
statement.
Use this form only when there is a change to report to Social Security
Form SSA-1425 (04-2008) EF (08-2008)

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