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:


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:


  • 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.


Employment Code:

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


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.


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.


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).



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


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:
RM 02226.015 - Instructions for Completing Form SSA-4132 - 08/23/2016
Batch run: 05/07/2018