Form SSA-1042S, Social Security Benefit Statement Instructions

Enter the beneficiary's full legal name as shown on Social Security records (first name, middle initial if any, and last name).

Enter the beneficiary's Social Security Number (all nine digits), with or without dashes, exactly as it appears on SSA records.

Enter the beneficiary's mailing address where SSA correspondence is sent, including street address, city, state, and ZIP code.

Enter the SSA claim or award number associated with this benefit exactly as shown, including any letters or leading zeros.

Enter a concise description explaining the amounts reported in Box 3 (Benefits Paid in 2024), such as the type(s) of benefit, periods covered, and any other details that clarify the payment.

Enter a short, clear explanation of the amount reported in Box 4 (benefits repaid to SSA in 2024), such as reason for repayment or details of the adjustment.

Enter the total amount of Social Security benefits paid to the beneficiary during 2024 as reported on Box 3.

Enter the total amount of Social Security benefits that were repaid to the Social Security Administration in 2024 as reported on Box 4.

Enter the net benefit amount for 2024 (Box 3 minus Box 4) as reported on Box 5. Fill only if 'Box 3 — Benefits Paid in 2024', 'Box 4 — Benefits Repaid to SSA in 2024' is calculated as Box 3 minus Box 4 (all).

Enter the tax rate that was applied to withhold federal income tax from the beneficiary's benefits for 2024 as reported in Box 6.

Enter the total amount of federal income tax withheld from the beneficiary's benefits during 2024 as reported in Box 7.

Enter the total amount of federal income tax refunded to the beneficiary during 2024 that reduces the withheld tax reported in Box 7, as reported in Box 8.

Enter the net tax withheld during 2024, calculated as the amount in Box 7 minus the amount in Box 8, as reported in Box 9. Fill only if 'Box 7: Amount of Tax Withheld', 'Box 8: Amount of Tax Refunded' is calculated as Box 7 minus Box 8 (all).