Form SSA-10-INST "Reporting Responsiblities for Widow's or Widower's Insurance Benefits"

What Is Form SSA-10-INST?

Form SSA-10-INST, Reporting Responsibilities for Widow's or Widower's Insurance Benefits, also known as SSA Form 10-INST, is a form used to inform the recipient of widow's or widower's insurance benefits about the reporting responsibilities. The document provides a list of changes you must report and the means to report them.

The form was issued by the Social Security Administration (SSA). The latest version of the document was released on April 1, 2017. All the prior editions are obsolete. A fillable Form SSA-10-INST is available for download and digital filing below.

The form is used to apply for the Social Security widow's or widower's insurance benefits. It has a related document Form SSA-10, Application for Widow's or Widower's Insurance Benefits.

ADVERTISEMENT

Form SSA-10-INST Instructions

Form SSA-10-INST contains detailed information on the cases you need to report to the SSA. If you do not report these changes on time, you may be forced to repay the overpayments. You also may be subjected to monetary penalties.

Report the following changes to the SSA:

  • Change of mailing address to avoid any delays in receiving checks;
  • Leaving the U.S for 30 days in a row or longer;
  • Change of your citizenship or immigration status;
  • Death of beneficiary;
  • Inability of the beneficiary to handle benefits;
  • Change in your work status and expected income you reported via Form SSA-10;
  • Any changes in your marital status, including divorce, marriage, and marriage annulment;
  • If you are condemned to a public institution by the court order or to an arrest in a penal institution or correctional facility for more than 30 days in a row;
  • If you start to receive pension or annuity payments not covered by Social Security;
  • Change in the amount of your annuity payments;
  • Stop of annuity payments or pension;
  • An unsatisfied warrant for more than 30 days, flight to avoid prosecution, or escape from custody.

If you are under the full retirement age, you also need to report your earnings every taxable year, in which you earn more than the exempt amount within 3 months and 15 days after the end of the year. If you do not report these changes, your benefits will be adjusted based on the earnings reported by your employer and your self-employment tax return.

Below are several ways to report the above-listed changes:

  1. Visit your local Social Security office; the address of the office you need will be provided on your claim receipt;
  2. Call your local office at the phone number provided on your claim report;
  3. Call the SSA toll-free number provided on the form and on the SSA official website;
  4. Visit the SSA official website and report the changes in the section "What You Can Do Online".

The SSA recommends you to copy all the documents you submit to the agency and keep these copies for future references.

ADVERTISEMENT

Download Form SSA-10-INST "Reporting Responsiblities for Widow's or Widower's Insurance Benefits"

127 times
Rate (4.5 / 5) 6 votes
Form Approved
Social Security Administration
OMB No. 0960 - 0004
REPORTING RESPONSIBILITIES FOR WIDOW'S OR WIDOWER'S INSURANCE BENEFITS
CHANGES TO BE REPORTED AND HOW TO REPORT
FAILURE TO REPORT MAY RESULT IN OVERPAYMENTS THAT
MUST BE REPAID, AND IN POSSIBLE MONETARY PENALTIES
You begin to receive a pension, annuity, or a lump
You change your mailing address for checks or
residence. (To avoid delay in receipt of checks you
sum payment based on your government
employment not covered by Social Security or your
should ALSO file a regular change of address
pension or annuity amount changes or stops.
notice with your post office.)
You have an unsatisfied warrant for more than 30
Your citizenship or immigration status changes.
continuous days for your arrest for a crime or
attempted crime that is a felony or flight to avoid
prosecution or confinement, escape from custody,
You go outside the U.S.A. for 30 consecutive days
and flight-escape. In most jurisdictions that do not
or longer.
classify crimes as felonies, this applies to a crime
that is punishable by death or imprisonment for a
term exceeding 1 year (regardless of the actual
Any beneficiary dies or becomes unable to handle
sentence imposed).
benefits.
WORK AND EARNINGS
For those under full retirement age, the law requires that
a report of earnings be filed with SSA within 3 months
Work Changes - On your application you told us
and 15 days after the end of any taxable year in which
you expect total earnings for
to be $
you earn more than the annual exempt amount. You
a month.
may contact SSA to file a report. Otherwise, SSA will use
the earnings reported by your employer(s) and your self-
You
(are)
(are not) earning wages of more than
employment tax return (if applicable) as the report of
$
a month.
earnings required by law and adjust benefits under the
earnings test. It is your responsibility to ensure that the
information you give concerning your earnings is correct.
You
(are)
(are not) self- employed rendering
You must furnish additional information as needed when
substantial services in your trade or business.
your benefit adjustment is not correct based on the
earnings on your record.
(Report AT ONCE if this work pattern changes)
HOW TO REPORT
You can make your reports by telephone, mail, in
Change of Marital Status - Marriage, divorce,
person, or online, whichever you prefer.
annulment of marriage. You must report a change
If you are awarded benefits, and one or more of the
in marital status even if you believe that an
above change(s) occur, you should report by:
exception applies.
Visiting the section "What You Can Do Online" at our
Custody Change or Disability Improves - Report if a
website at
www.socialsecurity.gov
www.socialsecurity.gov
person for whom you are filing, or who is in your
Calling us TOLL FREE at 1-800-772-1213; If you are
care dies, leaves your care or custody, changes
deaf or hearing impaired, calling us TOLL FREE at
address, or, if disabled, the condition improves.
TTY 1-800-325-0778; or
Calling, visiting or writing your local Social
You are confined for more than 30 continuous days
Security office at the phone number and address
to jail, prison, penal institution or correctional facility
shown on your claim receipt.
for conviction of a crime or you are confined to a
For general information about Social Security, visit
public institution by court order in connection
our web site at
www.socialsecurity.gov
www.socialsecurity.gov
with a crime.
NOTICE ABOUT DOCUMENTS
We recommend that you keep copies of all documents you submitted to us.
We are returning the documents you submitted with this claim.
(OVER)
Form SSA-10-INST (04-2017) UF
Destroy prior editions
Form Approved
Social Security Administration
OMB No. 0960 - 0004
REPORTING RESPONSIBILITIES FOR WIDOW'S OR WIDOWER'S INSURANCE BENEFITS
CHANGES TO BE REPORTED AND HOW TO REPORT
FAILURE TO REPORT MAY RESULT IN OVERPAYMENTS THAT
MUST BE REPAID, AND IN POSSIBLE MONETARY PENALTIES
You begin to receive a pension, annuity, or a lump
You change your mailing address for checks or
residence. (To avoid delay in receipt of checks you
sum payment based on your government
employment not covered by Social Security or your
should ALSO file a regular change of address
pension or annuity amount changes or stops.
notice with your post office.)
You have an unsatisfied warrant for more than 30
Your citizenship or immigration status changes.
continuous days for your arrest for a crime or
attempted crime that is a felony or flight to avoid
prosecution or confinement, escape from custody,
You go outside the U.S.A. for 30 consecutive days
and flight-escape. In most jurisdictions that do not
or longer.
classify crimes as felonies, this applies to a crime
that is punishable by death or imprisonment for a
term exceeding 1 year (regardless of the actual
Any beneficiary dies or becomes unable to handle
sentence imposed).
benefits.
WORK AND EARNINGS
For those under full retirement age, the law requires that
a report of earnings be filed with SSA within 3 months
Work Changes - On your application you told us
and 15 days after the end of any taxable year in which
you expect total earnings for
to be $
you earn more than the annual exempt amount. You
a month.
may contact SSA to file a report. Otherwise, SSA will use
the earnings reported by your employer(s) and your self-
You
(are)
(are not) earning wages of more than
employment tax return (if applicable) as the report of
$
a month.
earnings required by law and adjust benefits under the
earnings test. It is your responsibility to ensure that the
information you give concerning your earnings is correct.
You
(are)
(are not) self- employed rendering
You must furnish additional information as needed when
substantial services in your trade or business.
your benefit adjustment is not correct based on the
earnings on your record.
(Report AT ONCE if this work pattern changes)
HOW TO REPORT
You can make your reports by telephone, mail, in
Change of Marital Status - Marriage, divorce,
person, or online, whichever you prefer.
annulment of marriage. You must report a change
If you are awarded benefits, and one or more of the
in marital status even if you believe that an
above change(s) occur, you should report by:
exception applies.
Visiting the section "What You Can Do Online" at our
Custody Change or Disability Improves - Report if a
website at
www.socialsecurity.gov
www.socialsecurity.gov
person for whom you are filing, or who is in your
Calling us TOLL FREE at 1-800-772-1213; If you are
care dies, leaves your care or custody, changes
deaf or hearing impaired, calling us TOLL FREE at
address, or, if disabled, the condition improves.
TTY 1-800-325-0778; or
Calling, visiting or writing your local Social
You are confined for more than 30 continuous days
Security office at the phone number and address
to jail, prison, penal institution or correctional facility
shown on your claim receipt.
for conviction of a crime or you are confined to a
For general information about Social Security, visit
public institution by court order in connection
our web site at
www.socialsecurity.gov
www.socialsecurity.gov
with a crime.
NOTICE ABOUT DOCUMENTS
We recommend that you keep copies of all documents you submitted to us.
We are returning the documents you submitted with this claim.
(OVER)
Form SSA-10-INST (04-2017) UF
Destroy prior editions
Privacy Act Statement
Collection and Use of Personal Information
Section 202, 205, and 233 of the Social Security Act, as amended, authorize us to collect this information. We will use the
information you provide to determine eligibility of you or a dependent for Social Security benefits.
Furnishing us this information is voluntary. However, failing to provide us with all or part of the information may prevent
an accurate and timely decision on your entitlement or a dependent's entitlement to Social Security benefit payments.
We rarely use the information you supply us for any purpose other than for making a determination relating to your
entitlement or a dependent's entitlement to Social Security benefit payments. However, we may use it for the
administration and integrity of Social Security programs. We may also disclose information to another person or to
another agency in accordance with approved routine uses, which include but are not limited to the following:
1. To enable a third party or an agency to assist us in establishing rights to Social Security benefits
and/or coverage;
2. To comply with Federal laws requiring the release of information from our records (e.g., to the
Government Accountability Office and Department of Veterans' Affairs);
3. To make determinations for eligibility in similar health and income maintenance programs at the
Federal, State, and local level; and,
4. To facilitate statistical research, audit, or investigative activities necessary to assure the integrity
and improvement of our programs (e.g., to the Bureau of the Census).
We may also use the information you give us in computer matching programs. Matching programs compare our records
with records kept by other Federal, State, or local government agencies. Information from these matching programs can
be used to establish or verify a person's eligibility for Federally-funded or administered benefit programs and for
repayment of payments or delinquent debts under these programs.
A complete list of routine uses of the information you provided us is available in our System of Records Notice entitled,
Master Beneficiary Record, 60-0090. This notice, additional information regarding this form, and information regarding
our programs and systems, are available on-line at
www.socialsecurity.gov
www.socialsecurity.gov
or at your local Social Security office.
PAPERWORK REDUCTION ACT STATEMENT - This information collection meets the requirements of
44 U.S.C. §3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these
questions unless we display a valid Office of Management and Budget control number. The OMB control number for this
collection is 0960-0004. We estimate that it will take about 15 minutes to read the instructions, gather the facts, and
answer the questions. Send only comments relating to our time estimate above to SSA, 6401 Security Blvd.
Baltimore, MD 21235-6401.
Form SSA-10-INST (04-2017) UF
Page of 2