Form Ssa-L-93-Sm (04-11) - Retirement, Survivors And Disability Insurance Form (Page 2 of 7) in pdf

Form Ssa-L-93-Sm (04-11) - Retirement, Survivors And Disability Insurance Form Page 2

Page 2 of 7

About the Questionnaire

If the questionnaire shows only the IRS wage totals, it means we do not have copies of any Form W-2

wage reports for your employees for that tax year. Or, it may show that the Form W-2 wage totals we

have in our records are less than those that are on the Forms 941, 943, 944 or Schedule H (Form 1040)

returns you filed with the IRS.

We have enclosed a pamphlet entitled “Don’t Let Your Employees Down” with information to help you

complete the questionnaire. Or, you can go to “Reconciliation Process” at

For your convenience we have enclosed a self-addressed envelope. If you cannot use the envelope, please

mail the completed questionnaire and requested information to:

Social Security Administration

P.O. Box 33021

Baltimore, Maryland 21290-3021

We cannot correct your employees' wage records unless you give us the information that we requested.

This information is important. It could affect your employees' rights to future Social Security benefits

and the amount of those benefits. Please make sure that the information you give us will resolve the

problem. Always keep your wage records for four (4) years to back up your wage and tax reports, in case

SSA or the IRS have questions about them later.

If We Do Not Receive This Information

If you do not send the information we need we will refer this matter to the IRS. If the IRS finds that you

made a reporting error, they may charge you a penalty.

Suspect Social Security Fraud?

or call the Inspector General’s Fraud Hotline at 1-800-269-0271 (TTY 1-

Please visit

866-501-2101).

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SSA-L-93-SM (04-11)

Form Ssa-L-93-Sm (04-11) - Retirement, Survivors And Disability Insurance Form Page 2