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SSA-4-INST

Reporting Responsibilities For Child's Insurance Benefits

Download and Print the SSA-4-INST

Request may not be processed if the form is incomplete or illegible.

CHANGES TO BE REPORTED AND HOW TO REPORT
FAILURE TO REPORT MAY RESULT IN OVERPAYMENTS THAT MUST BE REPAID AND IN POSSIBLE MONETARY PENALTIES

You or any child changes mailing address for checks or residence. To avoid delay in receipt of checks you should ALSO file a regular change of address notice with your post office.

Any child's citizenship or immigration status changes.

Any beneficiary goes outside the U.S.A. for 30 consecutive days or longer.

Any beneficiary dies or becomes unable to handle benefits.

Work Changes - On your application you told us (Name of Child) expected total earnings for (Year)
to be $ .

(Name of Child) (is) (is not) earning wages of more than $_____.__ a month.
(Name of Child) (is) (is not) self- employed rendering substantial services in a trade or business.
(Report AT ONCE if this work pattern changes)

Custody Change - Report if a child for whom you are filing, or who is in your care dies, leaves your care or custody, or changes address.

The child age 13 or older has an unsatisfied warrant for their arrest for a crime or attempted crime that is a felony (or in jurisdictions that do not define crime as felonies, a crime that is punishable by death or imprisonment for a term exceeding 1 year).

The child age 13 or older has an unsatisfied warrant for a violation of probation or parole under Federal or State law.

A student, age 18 or over, stops attending school, reduces school attendance below full-time, changes schools, or is paid by an employer to attend school.

If the worker and stepchild's parent divorce. Benefits are not payable to a stepchild beginning with the month after the month the worker and stepchild's parent divorce. Promptly return any benefit payment received on behalf of the stepchild for the months after the month

And much more...

 
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