TN 15 (09-92)

RS 01403.037 Completion of Forms SSA-7011-F4, SSA-1002-F3, and SSA-1003-F3

A. PROCEDURE — COMPLETING FORM SSA-7011-F4

Complete the parts of the form that identify the SSA office and the employee on page 1 and top of page 3.

1. Additional Employee Identification

Add the following additional information on page 1, when available:

  • employee payroll or badge number;

  • name and address of place of employment, if different than parent company;

  • type of work;

  • position/grade (e.g., foreman)

  • shift;

  • establishment number;

  • reporting unit;

  • plant or project number;

  • period of employment.

2. Wage Information

Show periods for which wage or tip evidence is needed on either page 3 for annual information or page 4 for quarterly information.

3. Wages/Tips

Check boxes referring employer to items 6 and/or 7 on page 4, depending on the situation.

B. PROCEDURE — COMPLETING FORM SSA-1002-F3

Complete parts of the form that identify the SSA office and the employee on page 1 and top of page 2. For wage information:

  • Enter only the year(s) prior to 1988 for which wage information is needed.

  • Ask employer to complete items 13 through 15.

  • Annotate item 13 to show “and W-2's” as well as the IRS Form 943.

C. PROCEDURE — COMPLETING FORM SSA-1003-F3

Complete parts of the form that identify the SSA office and the employee on page 1 and top of page 2.

Enter only the years after 1987 for which wage information is needed.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0301403037
RS 01403.037 - Completion of Forms SSA-7011-F4, SSA-1002-F3, and SSA-1003-F3 - 02/15/1995
Batch run: 01/27/2009
Rev:02/15/1995