Annual Earnings Statement for Disability Benefits (SERS-220) Annual Earnings Statement for Disabilit 2026

1. Click ‘Get Form’ to open the Annual Earnings Statement in the editor.
2. In Section A, enter your Social Security Number and full name. This information is crucial for identification purposes.
3. Proceed to Section B and input your total annual earnings. If you have no earnings, write 'none' and move to Section E. Remember to include gross wages, salaries, tips, and net self-employment income.
4. If applicable, provide your employer's name and address in Section C. If you are self-employed, mark 'Yes' in Section D instead.
5. In Section E, read the certification statement carefully. By signing, you confirm that all provided information is accurate and understand the implications of exceeding income limitations.
6. Finally, fill in your daytime telephone number and address before signing and dating the form at the bottom.

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