Work Reporting Checklist worksheet
Use this checklist to organize earnings, hours, subsidies, trial work months, and SSA receipts.
| Item | Your notes |
|---|---|
| Use This Checklist To Organize Earnings | ____________________________ |
| Hours | ____________________________ |
| Subsidies | ____________________________ |
| Trial Work Months | ____________________________ |
| Ssa Receipts | ____________________________ |
| Employer or self-employment | ____________________________ |
| Month | ____________________________ |
| Gross earnings | ____________________________ |
| Hours worked | ____________________________ |
| Job duties | ____________________________ |
| Accommodation or reduced duties | ____________________________ |
| Date reported to SSA | ____________________________ |
Before you use this checklist
- Copy dates and instructions from the current SSA notice rather than memory.
- Keep originals and work from copies.
- Do not send Social Security numbers, bank information, or full medical files to an unverified recipient.
- Save filing confirmations and proof of any time-sensitive submission.