SSA-L9779 Retirement, Survivors and Disability Insurance: Earnings

Social Security Administration
Retirement, Survivors and Disability Insurance
Important Information

Date:
Claim Number:Igrr/-

$$-$gp
(A\

1

I am writing to ask your help in making sure that we are paying you the correct
amount of Social Security bendits. We need you t o give us current information,
abaut your work.

Earlier, you told us that your earnings this year would be about $ k x x % Your
plans, however, may have changed. Because we want to make sure that we are
paying you accurately, we want you to check your estimate for this year, and let us
know if it i s different. We also need to know about your work plans for 2006.

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T h e enclosed form has some questions about your work for this year and next year.

you complete it, please mail it in the enclosed envelope.

We need to ear from

you as soon as possible, because we need to know ' your estimate for 200A s stdl right.
Also, ifyou donot return this form by Oetober&OObkwe will use our2004 earnings
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estimate to decide how much we will pay you in the first part of 200

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7Thank you for t a n g the time to assist us- We would like to give you the best
possible service and hope that you b d this form a convenient way ta inform us
about your work plans.

U you have any questions, you can c a l l us toll free at 1-800-772-12
13,7:00 a.m.
to 7:00 p.m. Monday through Friday. We can answer most questions eyer the phone.
Our busiest times are the h t week of the month and Mondays. So, we may be
able to handle your call more quickly if you can call us at other times. If you
prefer to visit or c a l l one of OUT o&es, use the 800 number and we c a n give you the
a c e address and telephone number. Please have this letter w i t h you if you call or
visit an o&e. It will help us answer your ques~ons.
Sincerely,

Commissioner
Social Security Administration

Endosures:
Earnings Estimate Form SSA-L9779-SM-SUP
Envelope

Earsinesfar 200d apd 2006

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We have put together a list of questions that will help you update your eamhgs
estimate. Please answer them carefully. Before you answer our questions, we
want to talk briefly about how to estimate your earnings.

It may not be easy for you to i5gure ahead of t h e how much you will make in
200p and 200 But if you keep these p o i n m in mind, you should have no problem.
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If you are paid wages, base your estimate on what you expect to earn before
taxes or other deductionrs for the whole year. Be gure ta include bonuses,
vacation pay, sick pay, tips of $20 or more a month, and any copb.ibution that
you make from your salary to a tax deferred savings plan.

$.

a Drop from your estimate any money you w i l l get h m your employer
for work you did last year or before. Also, do not include:
a

a

Social Security, railroad or civil
service retirement, veterans,
black lung or public assistance

gifts or inheritances;

benefits;

assets;

pen~ionsand other retirement
payments which are not
reported on your W-2 form;

a

investment income;

a

interest from savings accounts;

year

gain (or Ims) from the sale of capital
'

rental income;
unemployment or worker's
compensaEion;
jury dutypayments.

life insurance annuities and
dividends;

a If you are self-employed, base your estimate on what you W k your net
earaings will be - just like on ur tax return. If you became entitled to Social
Security benefits before 200#841)do not include lltyour estimate any Federal
200d, and (2) do not include
agricultural program payments
self-employment income received in
fox work you
did before you became entitled to

If you get both wages and income h m self-employmeet, add the mo amounts
together. The total is your estimate.

Form SSA-L9779-SM-SUP(7-20%

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Page 2

d pmk
a

You will reach full retirement age in

e.

Beginning with the month of full retirement age, the earnings limit no longer
applies. If you will reach full retirement age in January 2001, you do not have
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to complete question 5 regarding your earnings for 2008.
I
I

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People who reach full r e m e n t age i4 February through D~ b e 2 0r 0 6 ~
y wages earned
should exclude &om their estimate of yearly earnings for 20
in the month they reach full retirement age and all following months. Selfemployment income should be prorated baaed on the number of months uxlder
full retirement age. That is, divide expsckd net e d g s (or loss) for 20
the number of months of self-employment and multip1y thia result by
the number of months in 200 before you reach full retirement age.

Ogby

5

Now, you are ready to answer the following questions about your earnings. And again,
for us t o hear vou,

Form SSA-L9579-SM-SUP (7-2009)
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Form Alq>roved

OMB No.091'%-1)330

Page 1
QuestionsFor

'a

1. Earlier,
told us
will earn
this year.
How much do
now think
will earn in
( " # H # # ~

you

.A

$~$'i;
you
20041

you

you

Q,
Show your earnings for the whole year, including amounts you w i l l
earnboth before and after you med for Social Security benefits.

Show your answer in the space below.
Wages
Net Self-EmploymentEarnings

Total Earnings

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So far you have figured out how much you plan to earn in 2006. Now you
need to go back, and estimate how much you will earn each We need
to know this because we pay you baaed on how much you will earn each month.

490

It wor like this. Usually, if you make more than the earnings limit, which
in 200% $12,8BQ we have to hold back some of your Social Secwity. But if
we know how much you plan ta earn in each month in 2006 we may be able to
pay you more.
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The same is true of self-employed people. The difference is that we will need
to h o w how many hours you work in each month, instead of the amount of
money you w i l l earn.

b
For the following months in 2008, you previously told us that you will not
earn over $l,O 0 and will not work over 45 hours in self-employment.

f

2. -liYou
work
each month

for wages, put an 'X'
in the box under
when you will earn $1,0@0or less. B e sure
?
to do it for the whole year.
-

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

r
Please go on t o the next question.
Form SSA-L9779-SM-SUP(7-2@1

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Page 2

3. Ifwork eachself-employed,
how
hours will you
month in
Be sure put something
YOU

are

20064

many
to

down foreachmonth. 6

Show your hours in the boxes below.
JAN - FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

To help us make sure that we understand your answers, we would like to
know if you have retired, or if you plan to retire this year.

4

youretired,ordo you plan toretirein 20064
Have
.
6
If you retired, or plan to retire from your regular (full-be)
employment in 200fifhnswer TES" to this question even if you work or
plan to work part-be.

Show an T" on the h e next to your answer.

NO, I have not retired and I am not going t o retire this year.

YES,I have retired, or plan to retire this year.
If you answered "yes", please show your retirement date in the space
below.

(MONTH, DAY, YEAR)
Please answer question 5 on the next page.

Form SSA-L977P-SM-SUP (7-200j)

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Page 3

L4) YYV- V P ~ & )

If you will reach full retirement age in January ZOO/, you da not have to
complete this question.

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Our last question is about your earnings in 2008. Please look ahead and
estimate how much you plan t o earn next year. We will use this information
to v d e how much we can pay you in 2 0 ~ If
3 you do not plan to w r k in
2006, show "0" as your s t i m a t e d e h g s m o u n t . Ifyou wiu attain full
retirement age in 200 , include only your earnings prior to the month you
become full retirement age, You must answer this question. If you do ,
not enter an mount in question 5, w e will use your estimake for 2006
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to decide bow much to pay you in 2006.

d

7

5

HOWmuch do you think you will earn in 20049
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Show your answer in the space below.

r

Remember, you need to
thisformassoonasp 'ble- Ifyoudonot
return it by October 3, 006, e will use your 200s arnings estimate to
decide how much to pay you in the fist part of 200$

g"%,

?

Please sign this form in the space below, and send it back to us in the
enclosed envelope. And again, thank you for your help.
I declare under penalty of perjury that I have exnmined a l l the information
on this form, and on any accompanying statements or forms, and it is true
and correct to the best of my knowledge.

Date

Your Signature

Also, please give us a telephone number where we can reach you during the
day

*

I

-Area Code

Telephone Number

Form SSA-L9779-SM-SUP(7-2~)$)

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Page 4
PRIVACY ACT STATEMENT

The Social Security Administration (SSA) iq authorized t o collect information on

this form under section 205 (a) and section 203 (&) (3), (4) of the Social Security Act.
Giving us thishdb~ationisvoluntary. You do not have to do it, but we may not be
paying you the right amount unless you give us this information.

We use the information you give us to insure that we are paying you correctly.

However, we may share this information with mother person ox government agency
to manage the Sacid Security pro@am or other programs that must be coordinated
with the SSA.

We may a h use the information you give us in computer matching programs.

Matching programs compare our records with those of other Federal, State, or local
government agencies. Many hgencies may use matching programs to h d or prove
that a person q u m e s fur ben6t.s paid by the Federal Government. The law allows
us to do this even if you do not agree to it.

Explanations about these and other reasons why information you provide.us may be
used or given out are avdable in Social Security offices. If you want to learn more
about this, contact m y Smial Security office.
PAPERWORK REDUCTION ACT STATEMENT

Paperwork Reduction Act Statement - This information collection meets the
requirements of44 U.S.C. Q 3507, aa amended by Section 2 of the h n e m o r k
on Act of 1996, You do not need to answer these questions unless we display
a valid office of Management and Budget control number, We estimate that it wiu

To find the nearest office, call 1-800-772-1213.
Send
. .
0 4 v conamm on our time estimate above to: SSA, I-,
Baltimore, i
W 21235-0001.

Form SSA-L977O-SM-SUP (7-2006)

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