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Get SSA-7161-OCR-SM 2004

Death Marriage Divorce Annulment (a) Name of parent 6. If you answered “Yes” to question 6 on the other side, complete the information below. (b) Check one Employee (a) Name of person (d) If ended, enter date work stopped Yes No SelfEmployed (c) Date work began (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 did he/she pay United States Social Security taxes on earnings from this work? 7. (e) Date reside.

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