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.