Caution: All Forms SSA-3964 must be forwarded to the State Agency.HOW TO PREPARE FORM SSA-3964
All information should be entered in the appropriate spaces under the self-explanatory headings. Ensure that complete information has been entered in columns 1 through 5 for each item listed. Total the entries in columns 4 and 5, enter the totals and the difference between the totals in the spaces provided. If more than one page of adjustments is being submitted, show the totals for each page. Complete items 6 and 7 on the first page only to show the total for all pages. The first page of the original copy of the adjustment report must be signed and dated by the preparer or the reporting official.
If more than one previous reporting was made for an employee, column 4 (Wages previously reported) should reflect the net total reported for the period being corrected. To facilitate the computation of contributions a separate page of form SSA-3964 should be used for each year for which different contribution rates are applicable. See rates below.
The original copy of this report, and additional copies if required by the State agency, should be forwarded to the State agency together with any contributions payable. A duplicate copy should be retained by the reporting entity or by the State agency.
Contact the State administrator for instructions on preparation of adjustments involving incorrect social security number or name information, tip income, agricultural wages, or any unusual reporting or coverage situations.
SUPPORTING STATEMENT WHEN FORM SSA-3964 REDUCES ANY WAGE AMOUNTS PREVIOUSLY REPORTED
When an entry on a form SSA-3964 reduces the amount of earnings previously reported for any wage earner, such report must include, or be accompanied by, a statement of the reason the original reporting of wages was incorrect.
The supporting statement should contain sufficient detail to enable the Social Security Administration to determine that a refund is valid. Also, the statement must be clearly related to the item or items to which it pertains. If the wages actually paid are less than that reported, the type of error must be specified in each case.
Note: With respect to wages reported for a wrong period or wrong individual, the form SSA-3964 must include an offsetting adjustment reporting the wages for the correct period or individual. If such an offsetting adjustment is not necessary, the reason must be specified.
CREDIT OR REFUND OF EXCESS CONTRIBUTIONS FOR OVER-THE-MAXIMUM REPORTINGS
When an adjustment is prepared to correct a reporting of more than the maximum wages creditable for the year for an employee and refund of the employee's share of contributions is claimed, the following information must be submitted on or with the form SSA-3964:
DO NOT USE FORM SSA-3964 FOR THESE CORRECTIONS
The form SSA-3964 should not be used:
CONTRIBUTION RATES AND MAXIMUM WAGES
1974 | .117 | (11-7/10%) | $13,200 |
1975 | .117 | (11-7/10%) | 14,100 |
1976 | .117 | (11-7/10%) | 15,300 |
1977 | .117 | (11-7/10%) | 16,500 |
1978 | .121 | (12-1/10%) | $17,700 |
1979 | .1226 | (12-26/100%) | 22,900 |
1980 | .1226 | (12-26/100%) | 25,900 |
1981 | .133 | (13-3/10%) | 29,700 |
Tit. 1, div. 10, ch. 12, exh. VIII CSR