Questions on the SSA-455-OCR-SM Scannable Mailer Form
Each question on the scannable mailer is referenced to a specific time period unique to that mailer. This “report period” usually begins with the 24th month prior to the month the mailer is sent and continues to the present, but may be a longer or shorter time period.

Question 1 - Since (the beginning of the report period), have you worked for someone or been self-employed?

Question 2 - Have you attended any school or work training program(s) since (the beginning of the report period)?

Question 3 - Since (the beginning of the report period), have you and your doctor discussed whether you can work, and if so, what did the doctor tell you?

Question 4 - Place an “X” in only one box (labeled Better, Same, and Worse) which best describes your health now as compared to (the beginning of the report period).

Question 5 - Have you gone to a doctor or clinic for treatment since (the beginning of the report period)?

Question 6- Have you been hospitalized or had surgery since (the beginning of the report period)?