RS 01403: Wage Evidence
TN 15 (09-92)
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.