Get Ssa-546 2012-2025

Filling out the SSA-546 form, also known as the Workers' Compensation/Public Disability Benefit Questionnaire, is an important step in determining your eligibility for Social Security disability insurance benefits. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully complete the SSA-546 form.

1. Press the ‘Get Form’ button to access the SSA-546 form and open it in the online editor.
2. In the first section, enter the name of the worker and the Social Security number. Ensure that the information is accurate, as it is essential for identification purposes.
3. Moving to question 1, specify the type of benefits you are receiving, have received, or expect to receive in connection with your disability. Check all that apply and be prepared to provide details in question 2.
4. For each selected benefit in question 1, fill in the claim number, employer, insurance carrier, and the date of injury or illness in the corresponding fields.
5. In question 3, indicate the state where you worked when the benefits began or where the injury occurred. Input the date of injury or illness, and ensure that the state is accurately selected.
6. Question 4 asks whether Social Security taxes were always paid on your earnings related to public disability benefits. Answer 'Yes' or 'No', and provide additional information if necessary.
7. In question 5, describe the status of your claim for workers' compensation or other public disability benefits. Check all that apply, and if applicable, indicate the date you expect a decision if an appeal is pending.
8. Question 6 requires you to specify how disability payments are or were made. Choose from options like weekly, monthly, or every two weeks, and provide explanations for any other payment intervals.
9. In question 7, list the amounts and periods for which disability benefits were made. Include details such as the type of benefit, amount, and duration of payments.
10. If you have received or been awarded lump-sum settlements, respond to question 8. If applicable, complete question 9 with the relevant details about the lump-sum payment, including dates and amounts.
11. Finally, read the important information section before signing the form. Include your telephone number and mailing address. If applicable, find witnesses to sign below your signature.
12. Once completed, save your changes. You may then download, print, or share the form as necessary.

Complete the SSA-546 online today to ensure your benefits are accurately assessed.