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SOCIAL SECURITY ADMINISTRATION OFFICE OF HEARINGS AND APPEALS Form Approved OMB No. 0960-0288 NOTICE REGARDING SUBSTITUTION OF PARTY UPON DEATH OF CLAIMANT NOTE: Please read the PRIVACY ACT/ PAPERWORK
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OMB No. 0960-0289 is a form used by the Social Security Administration for reporting wage information for individuals who have received workers' compensation benefits.
Individuals who have received workers' compensation benefits and need to report their wage information to the Social Security Administration are required to file OMB No. 0960-0289.
OMB No. 0960-0289 can be filled out online through the Social Security Administration's website or by completing a paper form and mailing it to the address provided.
The purpose of OMB No. 0960-0289 is to ensure that individuals who have received workers' compensation benefits are reporting their accurate wage information to the Social Security Administration.
The information that must be reported on OMB No. 0960-0289 includes the individual's name, Social Security number, earnings from work, and the amount of workers' compensation benefits received.
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Office of Management and Budget | The White House
Specifically, OMB's mission is to assist the President in meeting his policy, budget, management and regulatory objectives and to fulfill the agency's statutory ...‎President's Budget · ‎Information and Guidance · ‎Historical Tables · ‎Legislative
CLAIMANT'S MEDICATIONS PLEASE PRINT - RegInfo.gov
OMB No.0960-0289. CLAIMANT'S MEDICATIONS. A. To be completed by Hearing Office. (Claimant and Social Security Number). (Wage Earner and Social Security ...

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