Effective Dates: 12/05/2001 - Present Previous | Next

TN 5 (09-82)

RM 03146.099 Exhibits

A. Trust Fund Statistics Sysout

1. Page 1

TRUST FUND STATISTICS

			VAMAS RUN NUMBER: 41
TYPE OF EMPLOYMENT:	TAX RATE PERIODS	ITEMS		EARNINGS
REGULAR	1998	0	$	.00
REGULAR	1997	0	$	.00
REGULAR	1996	0	$	.00
REGULAR	1995	0	$	.00
REGULAR	1994	0	$	.00
REGULAR	1993	0	$	.00
REGULAR	1992	0	$	.00
REGULAR	1991	0	$	.00
REGULAR	1990	0	$	.00
REGULAR	1989	0	$	.00
REGULAR	1988	0	$	.00
REGULAR	1987	0	$	.00
REGULAR	1986	0	$	.00
REGULAR	1985	0	$	.00
REGULAR	1984	0	$	.00
REGULAR	1983	0	$	.00
REGULAR	1982	0	$	.00
REGULAR	1981	0	$	.00
REGULAR	1980	0	$	.00
REGULAR	1979	0	$	.00
REGULAR	1978	0	$	.00
REGULAR	1977	0	$	.00
REGULAR	1976	0	$	.00
REGULAR	1975	0	$	.00
REGULAR	1974	0	$	.00
REGULAR	1973	0	$	.00
REGULAR	1972	0	$	.00
REGULAR	1971	0	$	.00
REGULAR	197;	0	$	.00
REGULAR	1969	0	$	.00
REGULAR	1968	0	$	.00
REGULAR	1967	0	$	.00
REGULAR	1966	0	$	.00
REGULAR	1963 - 1965	0	$	.00
REGULAR	1962	0	$	.00
REGULAR	1960 - 1961	0	$	.00
REGULAR	1959	0	$	.00
REGULAR	1957 - 1958	0	$	.00
REGULAR	1954 - 1956	0	$	.00
REGULAR	1950 - 1953	0	$	.00
REGULAR	1937 - 1949	0	$	.00

ALL YEARS COMBINED		0	$	.00

2. Page 2

TRUST FUND STATISTICS

			VAMAS RUN NUMBER: 41
TYPE OF EMPLOYMENT:	TAX RATE PERIODS	ITEMS		EARNINGS
TIPS	1998	0	$	.00
TIPS	1997	0	$	.00
TIPS	1996	0	$	.00
TIPS	1995	0	$	.00
TIPS	1994	0	$	.00
TIPS	1993	0	$	.00
TIPS	1992	0	$	.00
TIPS	1991	0	$	.00
TIPS	1990	0	$	.00
TIPS	1989	0	$	.00
TIPS	1988	0	$	.00
TIPS	1987	0	$	.00
TIPS	1986	0	$	.00
TIPS	1985	0	$	.00
TIPS	1984	0	$	.00
TIPS	1983	0	$	.00
TIPS	1982	0	$	.00
TIPS	1981	0	$	.00
TIPS	1980	0	$	.00
TIPS	1979	0	$	.00
TIPS	1978	0	$	.00
TIPS	1977	0	$	.00
TIPS	1976	0	$	.00
TIPS	1975	0	$	.00
TIPS	1974	0	$	.00
TIPS	1973	0	$	.00
TIPS	1972	0	$	.00
TIPS	1971	0	$	.00
TIPS	1970	0	$	.00
TIPS	1969	0	$	.00
TIPS	1968	0	$	.00
TIPS	1967	0	$	.00
TIPS	1966	0	$	.00

ALL YEARS COMBINED		0	$	.00

3. Page 3

TRUST FUND STATISTICS

			VAMAS RUN NUMBER: 41
TYPE OF EMPLOYMENT:	TAX RATE PERIODS	ITEMS		EARNINGS
AGRICULTURAL	1998	0	$	.00
AGRICULTURAL	1997	0	$	.00
AGRICULTURAL	1996	0	$	.00
AGRICULTURAL	1995	0	$	.00
AGRICULTURAL	1994	0	$	.00
AGRICULTURAL	1993	0	$	.00
AGRICULTURAL	1992	0	$	.00
AGRICULTURAL	1991	0	$	.00
AGRICULTURAL	1990	0	$	.00
AGRICULTURAL	1989	0	$	.00
AGRICULTURAL	1988	0	$	.00
AGRICULTURAL	1987	0	$	.00
AGRICULTURAL	1986	0	$	.00
AGRICULTURAL	1985	0	$	.00
AGRICULTURAL	1984	0	$	.00
AGRICULTURAL	1983	0	$	.00
AGRICULTURAL	1982	0	$	.00
AGRICULTURAL	1981	0	$	.00
AGRICULTURAL	1980	0	$	.00
AGRICULTURAL	1979	0	$	.00
AGRICULTURAL	1978	0	$	.00
AGRICULTURAL	1977	0	$	.00
AGRICULTURAL	1976	0	$	.00
AGRICULTURAL	1975	0	$	.00
AGRICULTURAL	1974	0	$	.00
AGRICULTURAL	1973	0	$	.00
AGRICULTURAL	1972	0	$	.00
AGRICULTURAL	1971	0	$	.00
AGRICULTURAL	1970	0	$	.00
AGRICULTURAL	1969	0	$	.00
AGRICULTURAL	1968	0	$	.00
AGRICULTURAL	1967	0	$	.00
AGRICULTURAL	1966	0	$	.00
AGRICULTURAL	1963 - 1965	0	$	.00
AGRICULTURAL	1962	0	$	.00
AGRICULTURAL	1960 - 1961	0	$	.00
AGRICULTURAL	1959	0	$	.00
AGRICULTURAL	1957 - 1958	0	$	.00
AGRICULTURAL	1955 - 1956	0	$	.00

ALL YEARS COMBINED		0	$	.00

4. Page 4

TRUST FUND STATISTICS

			VAMAS RUN NUMBER: 41
TYPE OF EMPLOYMENT:	TAX RATE PERIODS	ITEMS		EARNINGS
SELF EMPLOYMENT	1998	0	$	.00
SELF EMPLOYMENT	1997	0	$	.00
SELF EMPLOYMENT	1996	0	$	.00
SELF EMPLOYMENT	1995	0	$	.00
SELF EMPLOYMENT	1994	0	$	.00
SELF EMPLOYMENT	1993	0	$	.00
SELF EMPLOYMENT	1992	0	$	.00
SELF EMPLOYMENT	1991	0	$	.00
SELF EMPLOYMENT	1990	0	$	.00
SELF EMPLOYMENT	1989	0	$	.00
SELF EMPLOYMENT	1988	0	$	.00
SELF EMPLOYMENT	1987	0	$	.00
SELF EMPLOYMENT	1986	0	$	.00
SELF EMPLOYMENT	1985	0	$	.00
SELF EMPLOYMENT	1984	0	$	.00
SELF EMPLOYMENT	1983	0	$	.00
SELF EMPLOYMENT	1982	0	$	.00
SELF EMPLOYMENT	1981	0	$	.00
SELF EMPLOYMENT	1980	0	$	.00
SELF EMPLOYMENT	1979	0	$	.00
SELF EMPLOYMENT	1978	0	$	.00
SELF EMPLOYMENT	1977	0	$	.00
SELF EMPLOYMENT	1976	0	$	.00
SELF EMPLOYMENT	1975	0	$	.00
SELF EMPLOYMENT	1974	0	$	.00
SELF EMPLOYMENT	1973	0	$	.00
SELF EMPLOYMENT	1972	0	$	.00
SELF EMPLOYMENT	1971	0	$	.00
SELF EMPLOYMENT	1970	0	$	.00
SELF EMPLOYMENT	1969	0	$	.00
SELF EMPLOYMENT	1968	0	$	.00
SELF EMPLOYMENT	1967	0	$	.00
SELF EMPLOYMENT	1966	0	$	.00
SELF EMPLOYMENT	1965	0	$	.00
SELF EMPLOYMENT	1964	0	$	.00
SELF EMPLOYMENT	1963	0	$	.00
SELF EMPLOYMENT	1962	0	$	.00
SELF EMPLOYMENT	1961	0	$	.00
SELF EMPLOYMENT	1960	0	$	.00
SELF EMPLOYMENT	1959	0	$	.00
SELF EMPLOYMENT	1958	0	$	.00
SELF EMPLOYMENT	1957	0	$	.00
SELF EMPLOYMENT	1956	0	$	.00
SELF EMPLOYMENT	1955	0	$	.00
SELF EMPLOYMENT	1954	0	$	.00
SELF EMPLOYMENT	1953	0	$	.00
SELF EMPLOYMENT	1952	0	$	.00
SELF EMPLOYMENT	1951	0	$	.00

ALL YEARS COMBINED		0	$	.00

5. Page 5

TRUST FUND STATISTICS

			VAMAS RUN NUMBER: 41
TYPE OF EMPLOYMENT:	TAX RATE PERIODS	ITEMS		EARNINGS

MILITARY	1998	0	$	.00
MILITARY	1997	0	$	.00
MILITARY	1996	0	$	.00
MILITARY	1995	0	$	.00
MILITARY	1994	0	$	.00
MILITARY	1993	0	$	.00
MILITARY	1992	0	$	.00
MILITARY	1991	0	$	.00
MILITARY	1990	0	$	.00
MILITARY	1989	0	$	.00
MILITARY	1988	0	$	.00
MILITARY	1987	0	$	.00
MILITARY	1986	0	$	.00
MILITARY	1985	0	$	.00
MILITARY	1984	0	$	.00
MILITARY	1983	0	$	.00
MILITARY	1982	0	$	.00
MILITARY	1981	0	$	.00
MILITARY	1980	0	$	.00
MILITARY	1979	0	$	.00
MILITARY	1978	0	$	.00
MILITARY	1977	0	$	.00
MILITARY	1976	0	$	.00
MILITARY	1975	0	$	.00
MILITARY	1974	0	$	.00
MILITARY	1973	0	$	.00
MILITARY	1972	0	$	.00
MILITARY	1971	0	$	.00
MILITARY	1970	0	$	.00
MILITARY	1969	0	$	.00
MILITARY	1968	0	$	.00
MILITARY	1967	0	$	.00
MILITARY	1966	0	$	.00
MILITARY	1965	0	$	.00
MILITARY	1964	0	$	.00
MILITARY	1963	0	$	.00
MILITARY	1962	0	$	.00
MILITARY	1961	0	$	.00
MILITARY	1960	0	$	.00
MILITARY	1959	0	$	.00
MILITARY	1958	0	$	.00
MILITARY	1957	0	$	.00
MILITARY	1956	0	$	.00
MILITARY	1955	0	$	.00
MILITARY	1954	0	$	.00
MILITARY	1953	0	$	.00
MILITARY	1952	0	$	.00
MILITARY	1951	0	$	.00
MILITARY	1950	0	$	.00
MILITARY	1949	0	$	.00
MILITARY	1948	0	$	.00
MILITARY	1947	0	$	.00
MILITARY	1946	0	$	.00
MILITARY	1945	0	$	.00
MILITARY	1944	0	$	.00
MILITARY	1943	0	$	.00
MILITARY	1942	0	$	.00
MILITARY	1941	0	$	.00
MILITARY	1940	0	$	.00

ALL YEARS COMBINED		0	$	.00

6. Page 6

TRUST FUND STATISTICS

			VAMAS RUN NUMBER: 41
TYPE OF EMPLOYMENT:	TAX RATE PERIODS	ITEMS		EARNINGS
MILITARY	1939	0	$	.00
MILITARY	1938	0	$	.00
MILITARY	1937	0	$	.00

ALL YEARS COMBINED		0	$	.00

STATE & LOCAL		0	$	.00

NON-TAXABLE		0	$	.00

IMPOSS PER REGULAR		0	$	.00

IMPOSS PERIOD S-E		0	$	.00

TRUST FUND TOTALS		0	$	.00

B. ERTRUST Sysout

INTERIM TRUST FUND ADJUSTMENT DATA FROM THE IRS-941 TAPE FILES (TS0 – TS1) FOR AQ – 02

--- 06/02/81 ---

* * * * QUARTERLY BREAKDOWNS * * * * *

QUARTER ENDING	REGULAR WAGES	CASH TIPS WAGES	TIPS DEEMED TO BE WAGES
MARCH 31, 1981	223.37
DECEMBER 31, 1980	100,287,939,867.18	11,700,501.44	101,029,763.65
SEPTEMBER 30, 1980	18,121.21	157.21	47.16
JUNE 30, 1980

*****MONEY TOTALS NOT INCLUDED IN ABOVE QUARTERLY BREAKDOWNS *****

QUARTER ENDING	REGULAR WAGES	CASH TIPS WAGES	THERE ARE NO QUARTERLY AGRICULTURAL WAGES	TIPS DEEMED TO BE WAGES
1978			900,000.00
1979	1,001.20	.10
1980	14,271.06	154.63		7.83-
1981
1982
1983
1984
1985	271,387,136.41

			VALIDATION TEST OUTPUT SR 3414

C. Trust Fund Ledgers

1. SSA-7775

a. Page 1

STATEMENT OF TOTAL EMPLOYEE WAGES (Forms 941 and 942) UNDER THE FEDERAL CONTRIBUTIONS ACT
AS RECORDED BY THE SOCIAL SECURITY ADMINISTRATION

ACCOUNTING QUARTER _____

	CURRENT AND PREVIOUS QUARTERS		ALL OTHER QUARTERS BY TAX RATE PERIOD (DOES NOT INCLUDE CURRENT OR PREVIOUS QUARTER)
Month And Day	(1) Current A/Q _____	(2) PREVIOUS A/Q ___ (Quarter preceding current quarter)	(3)	(4)	(5)	(6)	(7)

































TOTAL

Form SSA-7775 (4-82) Formerly CO-8027) Page 1 of 4

b. Page 2

STATEMENT OF TOTAL EMPLOYEE WAGES (Forms 941 and 942) UNDER THE FEDERAL CONTRIBUTIONS ACT AS RECORDED BY THE SOCIAL SECURITY ADMINISTRATION

ACCOUNTING QUARTER _____

	ALL OTHER QUARTERS BY TAX RATE PERIOD (DOES NOT INCLUDE CURRENT OR PREVIOUS QUARTER)
Month And Day	(8)	(9)	(10) 1974	(11) 1973	(12) 1972	(13) 1971	(14) 1970

































TOTAL

Form SSA-7775 (4-82) Formerly CO-8027) Page 2 of 4

c. Page 3

STATEMENT OF TOTAL EMPLOYEE WAGES (Forms 941 and 942) UNDER THE FEDERAL CONTRIBUTIONS ACT AS RECORDED BY THE SOCIAL SECURITY ADMINISTRATION

ACCOUNTING QUARTER _____

	ALL OTHER QUARTERS BY TAX RATE PERIOD (DOES NOT INCLUDE CURRENT OR PREVIOUS QUARTER)
Month And Day	(15) 1989	(16) 1988	(17) 1987	(18) 1986	(19) 1985-1983	(20) 1982	(21) 1981-1980

































TOTAL

Form SSA-7775 (4-82) Formerly CO-8027) Page 3 of 4

d. Page 4

STATEMENT OF TOTAL EMPLOYEE WAGES (Forms 941 and 942) UNDER THE FEDERAL CONTRIBUTIONS ACT AS RECORDED BY THE SOCIAL SECURITY ADMINISTRATION

ACCOUNTING QUARTER _____

	ALL OTHER QUARTERS BY TAX RATE PERIOD (DOES NOT INCLUDE CURRENT OR PREVIOUS QUARTER)
Month And Day	(22) 1959	(23) 1958-1957	(24) 1956-1954	(25) 1953-1950	(26) 1949-1937	(27) TO - DATE Col. 1 thru 26
































TOTAL

Form SSA-7775 (4-82) Formerly CO-8027) Page 4 of 4

2. SSA-7776

a. Page 1

STATEMENT OF TOTAL EMPLOYEE TIPS REPORTED UNDER THE FEDERAL INSURANCE CONTRIBUTIONS ACT AS RECORDED BY THE SOCIAL SECURITY ADMINISTRATION

ACCOUNTING QUARTER _____

	CURRENT AND PREVIOUS QUARTERS		ALL OTHERS BY TAX RATE PERIOD (Does not include current or previous quarter)
Month And Day	(28) Current A/Q ______	(29) PREVIOUS A/Q _____ (Quarter preceding current quarter)	(30)	(31)	(32)	(33)	(34)

































TOTAL

Form SSA-7776 (4-82) (formerly CO-8027a) Page 1 of 3

b. Page 2

STATEMENT OF TOTAL EMPLOYEE TIPS REPORTED UNDER THE FEDERAL INSURANCE CONTRIBUTIONS ACT AS RECORDED BY THE SOCIAL SECURITY ADMINISTRATION

ACCOUNTING QUARTER _____

	ALL OTHERS BY TAX RATE PERIOD (Does not include current or previous quarter)
Month And Day	(35)	(36)	(37)	(38) 1974	(39) 1973	(40) 1972	(41) 1971

































TOTAL

Form SSA-7776 (4-82) (formerly CO-8027a) Page 2 of 3

c. Page 3

STATEMENT OF TOTAL EMPLOYEE TIPS REPORTED UNDER THE FEDERAL INSURANCE CONTRIBUTIONS ACT AS RECORDED BY THE SOCIAL SECURITY ADMINISTRATION

ACCOUNTING QUARTER _____

	ALL OTHERS BY TAX RATE PERIOD (Does not include current or previous quarter)
Month And Day	(42) 1970	(43) 1989	(44) 1988	(45) 1987	(46) 1966	(47) TO - DATE Col. 28 thru 46

































TOTAL

Form SSA-7776 (4-82) (formerly CO-8027a) Page 3 of 3

3. SSA-7777

a. Page 1

STATEMENT OF TOTAL SELF EMPLOYED (Calendar, Adjustment, Short and Fiscal Year)
EARNINGS UNDER THE
FEDERAL CONTRIBUTIONS ACT AS RECORDED BY THE SOCIAL SECURITY ADMINISTRATION

Accounting Quarter _____

	YEARS
Month And Day	(74)	(75)	(76)	(77)	(78)	(79)	(80)	(81)	(82)



































TOTAL

Form SSA-7777 (4-82) (formerly CO-8027b) Page 1 of 4

b. Page 2

STATEMENT OF TOTAL SELF EMPLOYED (Calendar, Adjustment, Short and Fiscal Year) EARNINGS UNDER
THE FEDERAL CONTRIBUTIONS ACT AS RECORDED BY THE SOCIAL SECURITY ADMINISTRATION

ACCOUNTING QUARTER _____

	YEARS
Month And Day	(83)	(84)	(85) 1973	(86) 1972	(87) 1971	(88) 1970	(89) 1969	(90) 1968	(91) 1967

































TOTAL

Form SSA-7777 (4-82) (formerly CO-8027b) Page 2 of 4

c. Page 3

STATEMENT OF TOTAL SELF EMPLOYED (Calendar, Adjustment, Short and Fiscal Year) EARNINGS UNDER THE FEDERAL CONTRIBUTIONS ACT AS RECORDED BY THE SOCIAL SECURITY ADMINISTRATION

ACCOUNTING QUARTER _____

	YEARS
Month And Day	(92) 1966	(93) 1965	(94) 1964	(95) 1963	(96) 1962	(98) 1961	(98) 1960	(99) 1959	(100) 1958

































TOTAL

Form SSA-7777 (4-82) (formerly CO-8027b) Page 3 of 4

d. Page 4

STATEMENT OF TOTAL SELF EMPLOYED (Calendar, Adjustment, Short and Fiscal Year) EARNINGS UNDER THE FEDERAL CONTRIBUTIONS ACT
AS RECORDED BY THE SOCIAL SECURITY ADMINISTRATION

ACCOUNTING QUARTER _____

	YEARS
Month And Day	(101) 1957	(102) 1956	(103) 1955	(104) 1954	(105) 1953	(106) 1952	(107) 1951	(108) TO DATE Col. 74 thru 107



































TOTAL

Form SSA-7777 (4-82) (formerly CO-8027b) Page 4of 4

4. SSA-7778

a. Page 1

STATEMENT OF TOTAL AGRICULTURE WAGES (Forms 943) UNDER THE FEDERAL INSURANCE CONTRIBUTIONS ACT
AS RECORDED BY THE SOCIAL SECURITY ADMINISTRATION

Accounting Quarter ____

	CURRENT AND PREVIOUS YEAR		ALL OTHER YEARS BY TAX RATE PERIOD (Does not include current or previous years)
Month And Day	(48) CURRENT YEAR _____	(49) PREVIOUS YEAR _____	(50)	(51)	(52)	(53)	(54)	(55)	(56)



































TOTAL

Form SSA-7778 (4-82) (Formerly CO-8027c) Page 1 of 3

b. Page 2

STATEMENT OF TOTAL AGRICULTURE WAGES (Forms 943) UNDER THE FEDERAL CONTRIBUTIONS ACT
AS RECORDED BY THE SOCIAL SECURITY ADMINISTRATION

Accounting Quarter _______

	ALL OTHER YEARS BY TAX RATE PERIOD (Does not include current or previous years)
Month And Day	(57)	(58)	(59)	(60) 1972	(61) 1971	(62) 1970	(63) 1969	(64) 1968	(65) 1967


































TOTAL

Form SSA-7778 (4-82) (Formerly CO-8027c) Page 2 of 3

c. Page 3

STATEMENT OF TOTAL AGRICULTURE WAGES (Forms 943) UNDER THE FEDERAL CONTRIBUTIONS ACT
AS RECORDED BY THE SOCIAL SECURITY ADMINISTRATION

Accounting Quarter _______

	ALL OTHER YEARS BY TAX RATE PERIOD (Does not include current or previous years)
Month And Day	(66) 1966	(67) 1965-1963	(68) 1962	(69) 1961-1960	(70) 1959	(71) 1958-1957	(72) 1956-1955	(73) TO - DATE Col. 48 thru 72



































TOTAL

Form SSA-7778 (4-82) (Formerly CO-8027c) Page 3 of 3

5. SSA-7779

STATEMENT OF NOT ACCOUNTABLE EARNINGS

Accounting Quarter _____

	MILITARY REPORTING		STATE REPORTING		NON-TAXABLE EVIDENCE POSTING
Month And Dau	(109) TODAY	(110) TO DATE	(111) TODAY	(112) TO DATE	(113) TODAY	(114) TO DATE





































TOTAL

6. SSA-7780

7. SSA-7781

a. Page 1

b. Page 2

D. Trust Fund Certification Letter

1. Page 1

DEPARTMENT OF HEALTH & HUMAN SERVICES	Social Security Administration
Refer to:	Baltimore, MD 21235

(Address and title of designated
Treasury Department
Official)

Dear Sir:

There is herein certified to the Secretary of the Treasury, in accordance with Section 201 (a) (3), 201 (b) (1) and 1817 (a) (1) of the Social Security Act, the amount of wages for the periods shown below, as established in the records of the Social Security Administration from (month/day/year) to (month/day/year) from wage reports received from the Internal Revenue Service. There is also herein certified to the Secretary of the Treasury, in accordance with Section 201 (a) (4), 201 (b) (2) and 1817 (a) (2) of the Social Security Act, self-employment income for the periods shown below, as established in the records of the Social Security Administration from (month/day/year) to (month/day/year) from reports received from the Internal Revenue Service.

There is also herein certified to the Secretary of the Treasury the interim amount of wages for the period shown below, as established in the records of the Social Security Administration from the Internal Revenue Service 941T tape.

There is also herein certified to the Secretary of the Treasury the amount of wages for which the Pacific Maritime Association paid the employer taxes only, as authorized by the U.S. Treasury Department's letter of June 2, 1950 and as amended by the U.S. Treasury Department's letter of April 22, 1995.

There is also herein certified to the Secretary of the Treasury, amounts of tips deemed to be wages which are subject to employer tax under Section 3121(t) of the Internal Revenue code.

2. Page 2

(A)

(1)

Interim Trust Fund Adjustment Data

Quarter Ending, (month/day/year of current quarter)

(a)

Regular Wages

Amount of Wages	Tax Rate % and Trust Fund to be Credited
$	(Enter applicable	FOASI
$	combined employer/	FDI
$	employee tax rate)	FHI

(b)	Cash Tips Wages

Amount of Wages	Tax Rate % and Trust Fund to be Credited
$	(Enter applicable	FOASI
$	tip tax rate)	FDI
$		FHI

(2)	Previous Quarter, Ending (month, day, year)
(a)	Regular Wages

Amount of Wages	Tax Rate % and Trust Fund to be Credited
$	(Enter applicable	FOASI
$	combined employer/	FDI
$	employee tax rate)	FHI

Note: If wages for other quarters in the current year are present, change the heading of the above section 2 to “Previous quarters, (current year)” and enter all the other quarters' wages for that year in a combined entry.

3. Page 3

(A)

(3)

Interim Trust Fund Adjustment Data

Prior Year, (year)

(a)

Regular Wages

Amount of Wages	Tax Rate % and Trust Fund to be Credited		Employment (To be computed by Treasury)
$		FOASI
$		FDI
$		FHI

(b)	Cash Tips Wages

Amount of Wages	Tax Rate % and Trust Fund to be Credited		Employment Taxes (To be computed by Treasury)
$		FOASI
$		FDI
$		FHI

Note: For additional prior years repeat the formula above. Do not include wages for year reported as certified wages in (B) below.

4. Page 4

(A)

(4)

Interim Trust Fund Adjustment Data

Wages from Agriculture Employment

(a)

Agriculture Wages, (current year on ERTRUST SYSOUT) for the Adjustment of Appropriations in the Quarter Ending March 31, (current year on ERTRUST SYSOUT)

Amount of Wages	Tax Rate % and Trust Fund to be Credited		Employment Taxes (To be computed by Treasury)
$		FOASI
$		FDI
$		FHI

(b)	Agricultural Wages, (prior year on ERTURST SYSOUT) for the Adjustment of Appropriation in the Quarter Ending March 31, (prior year on ERTRUST SYSOUT)

Amount of Wages	Tax Rate % and Trust Fund to be Credited		Employment Taxes (To be computed by Treasury)
$		FOASI
$		FDI
$		FHI

Note: For additional prior years repeat the formula above. Do not include wages for years reported as certified wages in (B) below.

5. Page 5

(B)	All Other Previous Quarters--By Tax Rate Period
(1)	Regular Wages

Amount of Wages	Tax Rate % and Trust Fund to be Credited
$	1937-1949	2.000	FOASI
$	1950-1953	3.000	FOASI
$	1954-1956	4.000	FOASI
$	1957-1958	4.000	FOASI
$	1957-1958	.500	FDI
$	1959	4.500	FOASI
$	1959	.500	FDI
$	1960-1961	5.500	FOASI
$	1960-1961	.500	FDI
$	1962	5.750	FOASI
$	1962	.500	FDI
$	1963-1965	6.750	FOASI
$	1963-1965	.500	FDI
$	1966	7.000	FOASI
$	1966	.700	FDI
$	1966	.700	FHI
$	1967	7.100	FOASI
$	1967	.700	FDI
$	1967	1.000	FHI
$	1968	6.650	FOASI
$	1968	.950	FDI
$	1968	1.200	FHI
$	1969	7.450	FOASI
$	1969	.950	FDI
$	1969	1.200	FHI
$	1970	7.300	FOASI
$	1970	1.100	FDI
$	1970	1.200	FHI
$	1971-1972	8.100	FOASI
$	1971-1972	1.100	FDI
$	1971-1972	1.200	FHI
$	1973	8.600	FOASI
$	1973	1.100	FDI
$	1973	2.000	FHI
$	1974	8.750	FOASI
$	1974	1.150	FDI
$	1974	1.800	FHI
$	1975	8.750	FOASI
$	1975	1.150	FDI
$	1975	1.800	FHI

6. Page 6

(B)	All Other Previous Quarters--By Tax Rate Period (continued)
(1)	Regular Wages

Amount of Wages	Tax Rate % and Trust Fund to be Credited
$	1976	8.750	FOASI
$	1976	1.150	FDI
$	1976	1.800	FHI
$	1977	8.750	FOASI
$	1977	1.150	FDI
$	1977	1.800	FHI

(2)	Cash Tips Wages

Amount of Wages	Tax Rate % and Trust Fund to be Credited
$	1966	3.500	FOASI
$	1966	.350	FDI
$	1966	.350	FHI
$	1967	3.550	FOASI
$	1967	.350	FDI
$	1967	.500	FHI
$	1968	3.325	FOASI
$	1968	.475	FDI
$	1968	.600	FHI
$	1969	3.725	FOASI
$	1969	.475	FDI
$	1969	.600	FHI
$	1970	3.650	FOASI
$	1970	.500	FDI
$	1970	.600	FHI
$	1971-1972	4.050	FOASI
$	1971-1972	.550	FDI
$	1971-1972	.600	FHI
$	1973	4.300	FOASI
$	1973	.550	FDI
$	1973	1.000	FHI
$	1974	4.375	FOASI
$	1974	.575	FDI
$	1974	.900	FHI
$	1975	4.375	FOASI
$	1975	.575	FDI
$	1975	.900	FHI
$	1976	4.375	FOASI
$	1976	.575	FDI
$	1976	.900	FHI

7. Page 7

(B)	All Other Previous Quarters--By Tax Rate Period (continued)

(2)	Cash Tips Wages

Amount of Wages	Tax Rate % and Trust Fund to be Credited
$	1977	4.375	FOASI
$	1977	.575	FDI
$	1977	.900	FHI

(C)	Wages From Agricultural Employment

Amount of Wages	Tax Rate % and Trust Fund to be Credited
$	1955-1956	4.000	FOASI
$	1957-1958	4.000	FOASI
$	1957-1958	.500	FDI
$	1959	4.500	FOASI
$	1959	.500	FDI
$	1960-1961	5.500	FOASI
$	1960-1961	.500	FDI
$	1962	5.750	FOASI
$	1962	.500	FDI
$	1963-1965	6.750	FOASI
$	1963-1965	.500	FDI
$	1966	7.000	FOASI
$	1966	.700	FDI
$	1966	.700	FHI
$	1967	7.100	FOASI
$	1967	.700	FDI
$	1967	1.000	FHI
$	1968	6.650	FOASI
$	1968	.950	FDI
$	1968	1.200	FHI
$	1969	7.450	FOASI
$	1969	.950	FDI
$	1969	1.200	FHI
$	1970	7.300	FOASI
$	1970	1.100	FDI
$	1970	1.200	FHI
$	1971-1972	8.100	FOASI
$	1971-1972	1.100	FDI
$	1971-1972	1.200	FHI

8. Page 8

(C)	Wages From Agricultural Employment (continued)

Amount of Wages	Tax Rate % and Trust Fund to be Credited
$	1973	8.600	FOASI
$	1973	1.100	FDI
$	1973	2.000	FHI
$	1974	8.750	FOASI
$	1974	1.150	FDI
$	1974	1.800	FHI
$	1975	8.750	FOASI
$	1975	1.150	FDI
$	1975	1.800	FHI
$	1976	8.750	FOASI
$	1976	1.150	FDI
$	1976	1.800	FHI
$	1977	8.750	FOASI
$	1977	1.150	FDI
$	1977	1.800	FHI

(D)	Self-Employment Income

Amount of Earnings	Tax Rate % and Trust Fund to be Credited
$	1951-1953	2.2500	FOASI
$	1954-1956	3.0000	FOASI
$	1957-1958	3.0000	FOASI
$	1957-1958	.3750	FDI
$	1959	3.3750	FOASI
$	1959	.3750	FDI
$	1960-1961	4.1250	FOASI
$	1960-1961	.3750	FDI
$	1962	4.3250	FOASI
$	1962	.3750	FDI
$	1963-1965	5.0250	FOASI
$	1963-1965	.3750	FDI
$	1966	5.2750	FOASI
$	1966	.5250	FDI
$	1966	.3500	FHI
$	1967	5.3750	FOASI
$	1967	.5250	FDI
$	1967	.5000	FHI
$	1968	5.0875	FOASI
$	1968	.7125	FDI
$	1968	.6000	FHI

9. Page 9

(D)	Self-Employment Income (continued)

Amount of Earnings	Tax Rate % and Trust Fund to be Credited
$	1969	5.5875	FOASI
$	1969	.7125	FDI
$	1969	.6000	FHI
$	1970	5.4750	FOASI
$	1970	.8250	FDI
$	1970	.6000	FHI
$	1971	6.0750	FOASI
$	1971	.8250	FDI
$	1971	.6000	FHI
$	1972	6.0750	FOASI
$	1972	.8250	FDI
$	1972	.6000	FHI
$	1973	6.2050	FOASI
$	1973	.7950	FDI
$	1973	1.0000	FHI
$	1974	6.1850	FOASI
$	1974	.8150	FDI
$	1974	.9000	FHI
$	1975	6.1850	FOASI
$	1975	.8150	FDI
$	1975	.9000	FHI
$	1976	6.1850	FOASI
$	1976	.8150	FDI
$	1976	.9000	FHI
$	1977	6.1850	FOASI
$	1977	.8150	FDI
$	1977	.9000	FHI
$	1978	6.0100	FOASI
$	1978	1.0900	FDI
$	1978	1.0000	FHI
$	1979	6.0100	FOASI
$	1979	1.0400	FDI
$	1979	1.0500	FHI
$	1980	6.2725	FOASI
$	1980	.7775	FDI
$	1980	1.0500	FHI
$	1981	7.0250	FOASI
$	1981	.9750	FDI
$	1981	1.3000	FHI

10. Page 10

(E)	Wages Paid by Pacific Martime Association Per Specific Agreement with IRS Quarter Ending (month, day, year).

Wages in Excess of Maxium not Reported on Schedule A	Employer Tax Rate % and Trust Fund to be Credited
$	(Enter applicable	FOASI
$	employer tax rate)	FDI
$		FHI

(F)	Wages based on Section 3121(t) Tax (Tips Deemed to be Wages) Quarter Ending (month, date, year).

Tips Deemed to be wages	Employer Tax Rate % and Trust Fund to be Credited
$	(Enter applicable	FOASI
$	employer tax rate)	FDI
$		FHI

Please acknowledge receipt of this letter by signing and returning one of the enclosed copies.

Sincerely,

(Signature and title)
of designed official)

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0103146099

RM 03146.099 - Exhibits - 12/05/2001
Batch run: 12/05/2001
Rev:12/05/2001

Program Operations Manual System (POMS)

RM 03146.099 Exhibits

A. Trust Fund Statistics Sysout

1. Page 1

2. Page 2

3. Page 3

4. Page 4

5. Page 5

6. Page 6

B. ERTRUST Sysout

C. Trust Fund Ledgers

1. SSA-7775

a. Page 1

b. Page 2

c. Page 3

d. Page 4

2. SSA-7776

a. Page 1

b. Page 2

c. Page 3

3. SSA-7777

a. Page 1

b. Page 2

c. Page 3

d. Page 4

4. SSA-7778

a. Page 1

b. Page 2

c. Page 3

5. SSA-7779

6. SSA-7780

7. SSA-7781

a. Page 1

b. Page 2

D. Trust Fund Certification Letter

1. Page 1

2. Page 2

3. Page 3

4. Page 4

5. Page 5

6. Page 6

7. Page 7

8. Page 8

9. Page 9

10. Page 10