Indiana Disability Attorney

Serving Social Security disability claimants in Columbus, Bloomington,
and throughout South Central Indiana

Social Security Disability Monthly Wage Information

If your earnings are close to the substantial gainful activity level (see 20 C.F.R. § 404.1574), documentation from your employer may be essential to show the Social Security disability examiner that you are not actually performing substantial gainful activity. Your W-2 form may work fine for last year, especially if there is no question concerning the dates you worked. If there is a question about the dates worked last year, you may need information from your employer.

If you are working in the current year and a recent paystub does not show all necessary information, you may need earnings information from the employer. This form will gather it. You can also download and print the full PDF version of the Social Security Disability Monthly Wage Information Form.

Note that this form asks about vacation and sick pay. According to POMS DI 10505.010 C, only earnings paid as a result of actual work activity count. Thus, sick pay and vacation pay do not count for determining eligibility for Social Security disability benefits, although according to POMS DI 10505.010 D, bonuses do count.

To: ______________________________________________________

Re: ______________________________________________________

SSN: _____________________________________________________

Please show monthly gross income and income from vacation or sick pay for the months and years indicated:

SSD monthly wage information

Date: ________________________________
Signature: ________________________________

Title: ________________________________
Print Name: ________________________________

Continue to the full PDF version of the Social Security Disability Monthly Wage Information Form.

Areas Served: I provide representation for Social Security disability appeals in Columbus, Bloomington and across Central Indiana and Southern Indiana, including these cities and counties. Primary Counties: Bartholomew, Brown, Clay, Decatur, Franklin, Greene, Jackson, Jefferson, Jennings, Johnson, Lawrence, Marion, Martin, Monroe, Morgan, Orange, Owen, Putnam, Ripley, Rush, Scott, Shelby, Washington. Primary Cities: Austin, Batesville, Bedford, Bloomington, Bloomfield, Brookville, Brownstown, Cloverdale, Columbus, Dupont, Edinburgh, Elizabethtown, Ellettsville, Franklin, Gosport, Greensburg, Greenwood, Hope, Hartsville, Indianapolis, Linton, Madison, Martinsville, Medora, Mitchell, Mooresville, Nashville, New Whiteland, North Vernon, Paoli, Rushville, Saint Paul, Salem, Scottsburg, Shelbyville, Seymour, Spencer, Vernon, Versailles, and Worthington.

Experienced disability lawyers in other regions: North Carolina Social Security lawyer, Syracuse disability attorney William Brennan, Denver disability attorney, Allen Disability Law, Syracuse New York disability lawyer, Cincinnati disability attorney Mark Newman, Springfield disability lawyer , Syracuse Family Attorney, New Jersey Personal Injury Lawyer , Los Angeles Social Security Lawyer, Boston Criminal Defense Attorney,

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