If you answer "Yes" to any of the questions 3 through 8 below, turn this form over and continue on the back.
Work: Did anyone for whom you receive benefits work for someone else or own a business or farm in the past 15 months?
Live apart: Did any person for whom you receive benefits live apart from you during any of the past 15 months?
Citizenship: Has anyone for whom you receive benefits changed his/her citizenship or country of residence in the past 15 months?
Signing: You must sign your name in item 11 on the back of this form.
Witness: If this form is signed with a mark, a witness must sign below.
Other events: You are responsible for reporting any other event that may affect benefit payments.
| Question | Answer |
|---|---|
| Form Name | Form SSA-7161-OCR-SM |
| Form Length | 3 pages |
| Fillable? | Yes |
| Fillable fields | 64 |
| Avg. time to fill out | 11 min |
| Edition | 07-2023 |
| Issuing agency | Social Security Administration |
| Return within | 60 days |
| Other names | SSA-7161-OCR-SM, SSA-7161, SSA 7161, Form SSA-7161, 7162, SSA-7162, Report by Person Receiving Benefits |
| Official source | Form SSA-7161-OCR-SM (Rev 07-2023), Social Security Administration |
Form 7162 isn’t the one you’re looking for?