SSA-1383

Student Reporting Form

Download and Print the SSA-1383

Use this form only when there is a change to be reported.
Form Approved OMB No. 0960-0088 - TOE 240

PRINT NAME OF STUDENT

SOCIAL SECURITY CLAIM NUMBER ON WHICH BENEFITS ARE PAID

It is a nine-digit number (000-00-0000) followed by letter(s) C or HC. We cannot process your report without the correct claim number.

LETTER(S)

1. CHANGE OF ADDRESS (Print new address at bottom of form.) If the Social Security Administration is sending your payments to your financial organization, do you want this to continue?
YES - NO

2. WORKING AND WILL EARN OVER THE EXEMPT AMOUNT - $ for the year
(specify)
(specify)

a. I am working for wages of more than $ a month or performing substantial services in self-employment beginning with the month of . . . . . . .

b. I estimate that my total earnings for this taxable year will be . . . . . . . . . . . . . . . .
FILL IN BOTH BOXES - MONTH AND YEAR - AMOUNT - $

3. MARRIAGE OF STUDENT
DATE OF MARRIAGE (MONTH, DAY, YEAR)

4. NO LONGER ATTENDING ANY SCHOOL
(Do NOT report this item merely because school year ended if you intend to resume full-time attendance after a vacation period of not more than 4 full calendar months.) The last day that I attended school on a full-time basis was
MONTH, DAY, YEAR

5. REDUCED SCHOOL ATTENDANCE TO LESS THAN FULL-TIME
The last day that I attended school on a full-time basis was
MONTH, DAY, YEAR

6a. CHANGED SCHOOLS
I have arranged to transfer schools effective I am (will be) attending
full-time - part-time - MONTH, DAY, YEAR

b. NAME AND ADDRESS OF NEW SCHOOL (Give sufficient information for location of your records.)

c. TYPE OF NEW SCHOOL
Secondary (High school level or below)
Post-secondary (College, Junior College, Trade or Vocational)
OTHER
(specify)

d. STUDENT IDENTIFICATION NUMBER
STUDENT'S SOCIAL SECURITY NUMBER

e. DATE SCHOOL YEAR WILL END
MONTH, YEAR

7a. STUDENT'S EMPLOYER IS PAYING STUDENT TO ATTEND SCHOOL
I began attending school as part of my job on
MONTH, DAY, YEAR

b. NAME AND ADDRESS OF EMPLOYER

8. INCARCERATION FOR CONVICTION OF A CRIME Student is confined in a jail, prison, or other correctional institution based on a conviction of a crime.
DATE OF INCARCERATION (MONTH, DAY, YEAR)
And much more...