APPLICATION FOR BENEFITS

3 Social Security Wages Amount of OASDI taxable wages. Maximum is $87,000. 4 Social Security Tax Withheld Amount of OASDI tax withheld. Maximum is $5,394.00. 5 Medicare Wages and Tips Amount of HI or Medicare taxable wages. 6 Medicare Tax Withheld Amount of HI or Medicare tax withheld. 7 Social Security Tips Not used. Should be blank. ................
................