Form 7162 PDF Details

Managing Social Security benefits on behalf of another person is a responsibility laden with both moral and legal obligations, underscored by the completion and submission of specific forms like the SSA-7161-OCR-SM, commonly referred to as the 7162 form. This form serves as a critical report to the United States Social Security Administration from individuals receiving benefits for a child or for an adult incapable of handling their own funds. It highlights the importance of timely communication with the Social Security Administration regarding major life events that could influence benefit eligibility and distribution. Events such as changes in citizenship, marital status, employment, living arrangements, and the handling of received Social Security checks are meticulously covered. The form mandates the reporting within a 60-day window, underscoring the urgency and significance of these events in maintaining the integrity and appropriate allocation of benefits. Further, it serves as a safeguard ensuring that benefits are used in the best interest of the beneficiary, requiring detailed explanations for any funds not directly used for their immediate welfare. Failure to complete and return this form within the specified timeframe may result in a suspension of benefits, emphasizing the crucial role this form plays in the continuous support and well-being of the beneficiary. In addition, the declaration section towards the end of the form underscores the gravity of providing truthful and accurate information, reminding the payee of the legal implications of perjury or fraudulent reporting.

QuestionAnswer
Form NameForm 7162
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namessm 2307 form, sm answered any blank, form 7161, form ocr any online

Form Preview Example

7161

FORM APPROVED

 

SOCIAL SECURITY ADMINISTRATION

OMB NO. 0960-0049

REPORT TO UNITED STATES SOCIAL SECURITY ADMINISTRATION

BY PERSON RECEIVING BENEFITS FOR A CHILD OR FOR AN ADULT UNABLE TO HANDLE FUNDS IMPORTANT: FAILURE TO COMPLETE AND RETURN THIS FORM WITHIN 60 DAYS WILL RESULT IN A SUSPENSION OF BENEFITS. SIGN AND RETURN THIS FORM IN THE ENCLOSED ENVELOPE.

SEE INSTRUCTIONS ENCLOSED.

1.

Print your address here only if it is different from the one shown below.

2. Telephone number at which you may be contacted during the day.

•

IF YOU ANSWER “YES” TO ANY OF THE QUESTIONS 3 THROUGH 8 BELOW, PLEASE TURN THIS FORM OVER

AND CONTINUE ON THE BACK. YOU MUST SIGN YOUR NAME IN ITEM 11 ON THE BACK OF THIS FORM

3.

Has anyone for whom you receive benefits changed his/her citizenship or country

 

 

YES

NO

 

 

 

 

 

 

 

 

 

 

of residence in the past 15 months?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

Has anyone for whom you receive benefits married, had a divorce

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(or annulment) or died in the past 15 months?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.

 

 

 

 

 

 

 

 

 

 

 

 

Has the parent (natural, adoptive or stepparent) of any child for whom you

 

 

 

 

 

 

 

 

receive benefits died, married or had a divorce (or annulment) in the past 15

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

months? (It is not necessary that the parent have been receiving benefits.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.

Did anyone for whom you receive benefits work for someone else or own a

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

business or farm in the past 15 months?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.

Did any person for whom you receive benefits live apart from you during

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

any of the past 15 months?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.

Did you give the Social Security checks or the full amount of the benefits to

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

another person (for example, the beneficiary’s custodian or the beneficiary

 

 

 

 

 

 

 

 

himself) during the past 15 months?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9.

Were all Social Security benefits received during the past 15 months used for the

 

 

 

 

 

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

beneficiary and/or held for the beneficiary?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If “No”, explain in “Remarks” on the back of this form what was done with the benefits.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10. A. Show the manner in which any amounts not

 

B. Show the Title or Ownership of the Account:

 

 

 

 

 

used for the beneficiary are being held:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bank

Other

If “Other”, explain in

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Account

 

“Remarks” on the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

back of this form.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER REPORTABLE EVENTS

 

 

 

 

 

 

(For SSA Use Only)

 

 

 

 

In addition to the events listed on this form, you are

 

 

 

 

 

 

—

 

 

 

—

 

 

 

 

 

 

 

 

 

 

 

responsible for reporting any other event that may

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

affect benefit payments.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SSN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form SSA-7161-OCR-SM (03-2004) Destroy Prior Editions

7161

Continued on the Reverse

IF YOU HAVE ANSWERED “YES” TO ANY OF QUESTIONS 3 THROUGH 8 ON THE OTHER SIDE OF THIS FORM,YOU MUST COMPLETE THE CORRESPONDING BLOCK(S) BELOW. IF YOU ANSWERED “NO” TO ALL OF THE QUESTIONS 3 THROUGH 8 ON THE OTHER SIDE OF THE FORM,YOU SHOULD GO TO ITEM 11, SIGN, DATE, AND RETURN THE FORM.

3.

If you answered “Yes” to question 3 on the other side, complete the information below.

 

 

 

 

 

 

 

 

 

 

 

(a) Name of person

(b) Country of new

(c) Date

 

(d) Current country

(e) Date residence

 

citizenship

acquired

 

 

of residence

began

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

If you answered “Yes” to question 4 on the other side, complete the information below.

 

 

 

 

 

 

 

 

 

 

(a) Name of person

 

(b) Check which event occurred

(c) Date event

 

 

Marriage

Annulment

occurred

 

 

 

 

 

 

Divorce

 

Death

 

 

 

 

 

 

 

 

 

5.

If you answered “Yes” to question 5 on the other side, complete the information below.

 

 

 

 

 

 

 

 

 

 

(a) Name of parent

 

(b) Check which event occurred

(c) Date event

 

 

Death

 

Marriage

occurred

 

 

 

 

 

 

 

Divorce

 

Annulment

 

 

 

 

 

 

 

 

 

6.

If you answered “Yes” to question 6 on the other side, complete the information below.

 

 

 

 

 

 

 

 

 

 

 

 

(a) Name of person

 

(b) Check one

 

 

(c) Date work

 

 

Employee

Self-

began

 

 

 

 

 

 

 

 

 

Employed

 

 

 

 

 

 

 

 

 

 

 

(d)If ended, enter date work stopped (e) List each month that he/she worked 45 hours or less (Explain in Remarks)

 

(f) Was this work done in the United States or

(g) If you answered “yes” to (f), enter his/her

 

 

did he/she pay United States Social

 

total earnings for last year

$

 

 

Security taxes on earnings from this work?

AND give your estimate of this

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

year’s earnings.

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7. If you answered “Yes” to question 7 on the other side, complete the information below.

 

 

 

 

 

 

 

 

 

 

 

 

 

(a) Name of beneficiary who did not live

(b) Date bene-

(c) Reason for leaving

 

(d) Date beneficiary

 

with you

 

ficiary left

 

 

 

returned

 

 

 

 

 

 

 

 

 

 

(e)If you listed someone in (a) above who has not returned, enter the address where he/she can be reached. (Include ZIP code)

8.If you answered “Yes” to question 8 on the other side, show to whom the funds were given.

Remarks

IMPORTANT: I declare under penalty of perjury that I have examined all the information on this form, and on any accompanying statements or forms, and it is true and correct to the best of my knowledge. I understand that anyone who knowingly gives a false or misleading statement about a material fact in this information, or causes someone else to do so, commits a crime and may be sent to prison, or may face other penalties, or both.

11.

Signature or mark of payee (Note: If this form is signed with a mark, a witness must sign below.)

Date

 

 

 

 

 

 

 

12.

Signature of witness

Address (include ZIP code)

Date

 

 

 

 

 

 

 

Form SSA-7161-OCR-SM (03-2004)

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To be able to fill out this PDF document, make sure you type in the information you need in every single field:

1. While filling out the ssa 7161 form, be sure to include all needed blank fields in the associated part. This will help to expedite the process, allowing your information to be handled swiftly and properly.

Part number 1 for completing form sm 03

2. Once your current task is complete, take the next step – fill out all of these fields - Has the parent natural adoptive or, Did anyone for whom you receive, Did any person for whom you, Did you give the Social Security, Were all Social Security benefits, YES, Show the manner in which any, Show the Title or Ownership of the, Bank Account, Other, If Other explain in Remarks on the, OTHER REPORTABLE EVENTS In, and For SSA Use Only with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

form sm 03 conclusion process described (portion 2)

Always be really careful while filling out Did anyone for whom you receive and Show the Title or Ownership of the, because this is where a lot of people make errors.

3. Your next part is straightforward - fill out all the form fields in OTHER REPORTABLE EVENTS In, Form SSAOCRSM Destroy Prior, SSN, and Continued on the Reverse in order to complete this segment.

form sm 03 writing process outlined (portion 3)

4. It's time to proceed to this next section! Here you will get these a Name of person, citizenship, acquired, of residence, began, If you answered Yes to question, a Name of person, b Check which event occurred, c Date event, Marriage Divorce, Annulment Death, occurred, If you answered Yes to question, a Name of parent, and b Check which event occurred empty form fields to do.

form sm 03 completion process explained (portion 4)

5. Lastly, the following final subsection is what you should complete before finalizing the form. The fields at issue include the following: a Name of beneficiary who did not, b Date bene, c Reason for leaving, with you with you, ficiary left, d Date beneficiary, returned, e If you listed someone in a above, Include ZIP code, If you answered Yes to question, Remarks, IMPORTANT I declare under penalty, Signature or mark of payee Note If, Date, and Signature of witness.

How to complete form sm 03 step 5

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