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I affirm that all information I have given in this document is true. SIGNATURE OF APPLICANT SIGNATURE First name middle initial last name Write in ink DATE Month day year TELEPHONE NUMBER Area Code MAILING ADDRESS Number and street Apt. SOCIAL SECURITY ADMINISTRATION TOE 420 Form Approved OMB No. 0960-0001 CERTIFICATE OF SUPPORT There is a time limitation for the filing of this certificate. It should be filed promptly. DO NOT WRITE IN THIS SPACE Enter Name of Wage Earner or Self-Employed...
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Enter name of wage refers to the name or title of the wage or salary that is being reported.
Employers or individuals who are responsible for reporting wages or salaries are required to file enter name of wage.
Enter name of wage should be filled out by providing the specific name or title of the wage or salary being reported.
The purpose of enter name of wage is to accurately report the name or title of the wage or salary for record-keeping and tax purposes.
The enter name of wage should include the specific name or title of the wage or salary being reported, along with any additional relevant information.
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