Basic (07-14)

RM 02226.015 Instructions for Completing Form SSA-4132

A. Policy on the Form SSA-4132

The Division of Earnings and Business Services (DEBS) will use the instructions in this section to complete the individual fields on the Form SSA-4132 (Interoffice Blanket Adjustments).

B. Instructions for completing Form SSA-4132

Use the following chart to fill-in the appropriate field on the Form SSA-4132. To view a facsimile of Form SSA-4132, see RM 02226.005D:

Field

How to Complete

Number of pages:

  • One page report, enter 1 of 1;

  • Multi-page report, enter number of the page and the last page number of the report on each page and enter T – (last page number) in red, in upper left hand corner of form.

NOTE: Multi-page could represent more than one Form SSA-4132 or attached forms or listings.

Types of Modification (TOM):

Check Types of Modification block, that the adjustment represents:

  • Block 60 if Employment Code is being corrected;

  • Block 63 if EIN is being corrected;

  • Block 66 if Reporting Period is being corrected or if both Reporting Period and EIN are being corrected;

  • Block 68 if earnings are being converted to tips or vice versa;

  • Block 70-72, if adjustment is to produce decrease earnings amounts (credits);

  • Block 73-75, if adjustment is to produce increase earnings amounts (debits).

Microprints or Microfilm:

Check appropriate block:

  • Microprints attached; or

  • Microfilm required.

Annual, Qrtly, Mixed or Sensitive Report:

Identify type of reporting periods for items:

  • If all items are annual, check “Annual” block;

  • If all items are quarterly, check “Quarterly” block;

  • If items are both (annual and quarterly), check mixed block;

  • If adjustment is, classified “Sensitive,” check Sensitive Report (show entry in red).

NOTE: The 800# Employer Reporting Specialist is the only one authorized to complete the Sensitive Report field.

Employer Name

Enter employer’s name:

EIN

  • Enter Employer Identification Number; or

  • Enter incorrect EIN for TOM code 63.

Correct EIN

Enter correct EIN, if TOM code is 63.

NOTE: Under TOM code 66, it is permissible to correct both the Reporting Period and EIN.

Decrease Period/Increase Period:

Use the “decrease period” or “increase period” field when using the appropriate TOM code:

  • TOM 60 – Yes if decrease or No if increase;

  • TOM 63 – Yes if decrease or No if increase;

  • TOM 66 – Yes if decrease or No if increase;

  • TOM 68 – Yes if decrease or No if increase;

  • TOM 70-72 – Yes if decrease or No if increase;

  • TOM 73-75 - No if decrease or Yes if increase.

Employment Code

A-H-L-M-Q (R-S)

Enter employment code as follows:

  • Agriculture, transcribe “A”;

  • Household, transcribe “H”;

  • Limitation of Liability (state and local) , transcribe “L”;

  • Military, transcribe “M”;

  • Medicare Qualified Government Employment (MQGE) , transcribe “Q”;

  • Railroad – Non-FICA, transcribe “R”;

  • State FICA, transcribe “S”;

Other - leave blank.

(Correct)

Employment Code:

Use this when the TOM is Code 60. Enter correct employment code from the list above.

ESTAB/PRU:

Establishment number or Payroll Record Unit

Complete the “ESTAB PRU” as required (up to four records).

  • Enter ESTAB number (regular report) if part of employer record;

  • Enter PRU number (State and Local report), if part of employer record.

NOTE: Refer to the note after this chart if more than four records.

FICA Wage Total

Enter total adjusted wages in the “FICA Wage total” field.

  • If entire report, enter total from annual Employer Report Query Response (ERQR).

  • If segment of report, determine total.

FICA Tip Total

Enter the total adjusted tips in the “FICA Tip total” field.

  • If entire report, enter total from ERQR (Annual).

  • If segment of report, determine total.

Medicare Wage Total

Enter adjusted Medicare in the “Medicare Wage total” field:

  • If entire report, enter total from ERQR (Annual).

  • If segment of report, determine the total.

Items

Enter the total adjusted items:

  • Use total from ERQR (annual);

  • Enter estimate, if unknown.

Report Film Reference:

Complete the “Report Film Reference” field in all cases:

  • Enter reference to reflect the report the technician is keying the source data from;

  • If source is different from the corrected report; then you must complete the “Cancelled Report” field.

(Transcribe first six-digits of Microfilm Report Number quarter.)

NOTE: See the example provided below this chart.

SSN

Enter Social Security number, for items listed.

NOTE: If no SSN, enter all zero (000-00-0000).

Initials (1st and 2nd):

Enter wage earners initials for first and middle name, if applicable.

NOTE: If no initial, leave blank.

Employee Last Name:

Enter Last Name, if items to be listed.

NOTE: If the keyed items are from attachments, enter “See Attached.”

FICA Wages:

Enter the keyed wages for each item and total for all listed.

FICA Tips:

Enter the keyed tips for each item and the total for all listed.

Medicare Wages:

Enter the keyed Medicare wages for each item and the total for all items listed.

Cancelled Report:

Enter the MRN/ECN of the cancelled report:

  • Complete if MRN/ECN of report being cancelled is different than shown in report film reference; or

  • Complete if multiple reports are involved and OEO is retaining one of the reports.

Retained Report:

Enter MRN/ECN of retained report; complete, if multiple reports are involved and the other report been cancelled.

Authority For This Adjustment:

NOTE: This is a mandatory field.

Enter “authority for this adjustment”:

  • If appropriate, check the block that reflects the authority;

  • If not, enter the reason in the “Other” field; and

  • Show the type of workload investigated in the beginning of authorization statement (i.e., RECON, 6494, etc.).

Examples of the authorization statements:

  • Canceled twice in error;

  • Non-FICA, Railroad;

  • Duplicate, also processed under EIN 69-0000000.

PPD By and Date:

(Prepared By)

Enter the clerk first initial and last name and the current date in the appropriate field (e.g., J. Doe and MM/DD/YY).

Location:

 

Enter the Division, Branch and Unit Number (DBS/BSB-I/Unit XX).

Authorizer:

The Manager or the Management Support Specialist (MSS) should enter their signature.

NOTE: Additional handling instruction for ESTAB/PRU entry when it is over four records:

  1. 1. 

    Obtain a microprint of the Employer Report Query (ERQR, which reflected the related employer report information);

  2. 2. 

    Block out the ERQR information of any unrelated records or cut the pertinent information out and tape it on another piece of paper;

  3. 3. 

    Line through any establishment record not involved;

  4. 4. 

    Transcribe the first sequence to be keyed followed by the last sequence to be keyed, to the right of the establishment record;

  5. 5. 

    Adjust the totals as required, if entire establishment is not keyed;

  6. 6. 

    Transcribe in the “Employee Last Name” field: “See attached for keying employer information”;

  7. 7. 

    Complete the Report Film Reference field on the Form SSA-4132.

    • In the “From Sequence” field, show the first sequence keyed in the first establishment.

    • In the “To Sequence” field, show the last sequence keyed in the last establishment.

      NOTE: Establishments are in sequential order on the ERQR; however, in the report, they may not be in order.

    • Attach the microprint of the employer information to the Form SSA-4132.

Example for the Report Film Reference entry:

Items keyed from the original Form W-2 report to cancel adjustment made in error.

  1. 1. 

    If the items are to be data entered from microprints or microfilm, enter that information in the Microprints attached/Microfilm required field.

  2. 2. 

    If annual report, transcribe the following:

    • The first six-digits of Microfilm Report Number quarter;

    • Five-digit sequence of first item keyed from (From Sequence);

    • Five-digit sequence of last item keyed from (To Sequence).

C. Procedure for handling completed Forms SSA-4132

After preparing the Form SSA-4132, forward it to the Wilkes-Barre Direct Operations Center (WBDOC) for processing.

NOTE: DBS should handle sensitive reports in accordance with the current internal operation instructions.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0102226015
RM 02226.015 - Instructions for Completing Form SSA-4132 - 08/23/2016
Batch run: 05/07/2018
Rev:08/23/2016