TENNESSEE DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT
SOCIAL SECURITY NUMBER CORRECTION
Wage Records Unit 220 French Landing Drive Nashville, Tennessee 37243 Phone: (615) 741-3280 Fax: (615) 741-7214
This form should be used to correct social security numbers incorrectly reported on the Wage Report (LB-0851). Name of Employer __________________________________________ Employer Address ________________________________________ ________________________________________ ________________________________________ Employer Account No. ____________________ Federal ID No. __________________________
( ) Phone No. ______________________________
Signature ________________________________________
Quarter/Year
SSN as reported
Wages
Correct SSN
Name of Employee
LB-0755 (R. 9/06)
RDA N/A