EAU Adj 4427 

                                      MISSOURI DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS 
                                      SOCIAL SECURITY NUMBER CORRECTION 
 
Missouri Employer Account Number  

Employer Name and Address   ______________________________________________________________________  

              ______________________________________________________________________  

              ______________________________________________________________________  

              ______________________________________________________________________  

Employee Name__________________________________________________________________________________  

Incorrect Social Security No.  _______________________________________________________________________  

Correct Social Security No. _________________________________________________________________________  

Quarter(s) Involved _______________________________________________________________________________  

Requestor’s Name ________________________________________________________________________________  

Requestor’s Phone Number _________________________________________________________________________  

Reason:  ________________________________________________________________________________________  

 _______________________________________________________________________________________________  

 _______________________________________________________________________________________________  

 _______________________________________________________________________________________________  

 _______________________________________________________________________________________________  

 _______________________________________________________________________________________________  

 _______________________________________________________________________________________________  

 _______________________________________________________________________________________________  

 IMPORTANT: If needed, call 573-751-1995 for assistance in the translation and understanding 
 of the information in this document. 
 ¡IMPORTANTE!: Si es necesario, llame al 573-751-1995 para asistencia en la traducción y 
 entendimiento de la información en este documento. 
 Missouri Division of Employment Security is an equal opportunity employer/program. Auxiliary aids and services 
 are available upon request to individuals with disabilities.   TDD/TTY: 800-735-2966   Relay Missouri: 711 
                                                                                         MODES-4427 (10-15) 
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