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.
Please show monthly gross income and income from vacation or sick pay for the months and years indicated:
Print Name: ________________________________
We handle California Social Security disability claims for claimants from San Diego and nearby areas, including these counties and cities:
Imperial, Orange, Riverside, and San Diego.
Imperial County: Brawley, Calexico, and El Centro.
Orange County: Anaheim, Buena Park, Costa Mesa, Fountain Valley, Fullerton, Garden Grove, Huntington Beach, Irvine, La Habra, Laguna Niguel, Lake Forest, Mission Viejo, Newport Beach, Orange, Santa Ana, Tustin, Westminster, and Yorba Linda.
Riverside County: Corona, Hemet, Moreno Valley, Palm Desert, Palm Springs, Riverside, and Temecula.
San Diego County: Carlsbad, Chula Vista, El Cajon, Encinitas, Escondido, La Mesa, National City, Oceanside, Poway, Ramona, San Diego, San Marcos, Santee, and Vista.
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