Revised SSA-85 - Used only for Transaction Accuracy Review FY2011

INFORMATION NEEDED TO REVIEW YOUR SOCIAL SECURITY CLAIM
Claim Number: XXX-XXPlease have documents or proof of the ITEMS CHECKED below available for your interview
if you have them in your possession. This will help us complete the review of your claim more
quickly. Information regarding any items that are not checked but may pertain to you should
also be mentioned during the interview.

Social Security or Medicare Card for
Birth or baptismal certificate recorded before you were age 5 – otherwise, at least two
of the following documents are needed : school records, census records, delayed birth
certificate, children’s birth certificates, family Bible, naturalization certificate, etc.
Records of age will also be needed for
Marriage Certificates for you and
Divorce or annulment decrees for all prior marriages
Death Certificates for
Social Security numbers for all former spouses
Proof of military service
Pay Slips or W-2 Forms for
Self-employment tax returns for
Moved earnings language here (as mentioned in Justification)
A copy of the earnings record for the account on which you are receiving benefits is
enclosed. Please review the earnings and compare them with your records. I have
highlighted some specific years that I would like to discuss with you.
If you disagree with any of these earnings, please have your records available at the
time of the interview. W2 forms are the best evidence of wages. Tax returns and proof
of filing are the best evidence of self-employment wages.
Other:

Form SSA-85

Removed the introductory section for The Earnings
Record, and placed the disagreement language here
near the new earnings record language.