Form SSA-7163 03-2014 EF 03-2014 Destroy Prior Editions Page 1 If you need more space use the REMARKS section on Page 2. Form Approved OMB No* 0960-0050 TOE 220 SOCIAL SECURITY ADMINISTRATION QUESTIONNAIRE ABOUT EMPLOYMENT OR SELF-EMPLOYMENT OUTSIDE THE UNITED STATES See Page 3 for Privacy Act Statement PLEASE PRINT YOUR ANSWERS NAME OF WORKER ON WHOSE ACCOUNT BENEFITS ARE BEING PAID WORKER S SOCIAL SECURITY CLAIM NUMBER NAME OF EMPLOYED OR SELF-EMPLOYED BENEFICIARY BENEFICIARY S SOCIAL SECURITY NUMBER If different from worker s 1. Give the following information about your employment or self-employment outside the United States. NAME AND ADDRESS OF EMPLOYER IF SELF-EMPLOYED SHOW SELF AND ADDRESS OF YOUR TRADE OR BUSINESS* TYPE OF BUSINESS Work Period DATE BEGAN Month Day Year DATE ENDED Month Day Year IF NOT ENDED PRINT NOT ENDED. 2. List any month s of the work period s shown in item 1 in which you worked 45 hours or less and explain fully MONTH EXPLANATION OF WHY YOU WERE EMPLOYED OR....
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How to fill out the SSA-7163 online
This guide provides clear, step-by-step instructions for completing the SSA-7163 form, which is a questionnaire about employment or self-employment outside the United States. The process of filling out this form online is designed to be straightforward and user-friendly.
Follow the steps to successfully complete your SSA-7163 online.
- Click the ‘Get Form’ button to access the SSA-7163 document and begin the completion process. Ensure you have a reliable internet connection for smooth access.
- Provide the name of the worker on whose account benefits are being paid, and include their Social Security Claim Number. If applicable, include the name and Social Security Number of the employed or self-employed beneficiary.
- In the first section, provide complete details about your employment or self-employment outside the United States. Include the work period, type of business, and name and address of the employer or trade/business.
- List any month(s) during the work period where you worked 45 hours or less. Explain why you were engaged in fewer hours, and attach any relevant employment agreements as necessary.
- If you were employed, indicate whether the employment was covered under the United States Social Security program. If yes, report the total wages earned each year during the work period.
- For self-employment inquiries, confirm your legal residency status or citizenship. If you chose coverage under a different Social Security program, specify the country. Attach any required documents if necessary.
- Indicate if you filed income tax returns with the IRS for the relevant years. If affirming, attach the required tax documents. If not, provide detailed financial information regarding gross earnings, expenses, and earnings net.
- Finally, complete the declaration portion by signing and dating the form, and include your mailing address and telephone number. If signed by mark, ensure two witnesses sign as well.
- Review all provided information for accuracy, then save your changes. You can download, print, or share the completed SSA-7163 form as needed.
Start completing your SSA-7163 form online today for a streamlined filing process.
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Form SSA-7163 (03-2014) EF (03-2014). Destroy Prior Editions. SOCIAL SECURITY...
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