Supporting Statement for Form SSA-58
Modified Benefit Formula Questionnaire-Employer
20 CFR 404.213
OMB No. 0960-0477
Introduction/Authoring Laws and Regulations
Sections 215(a)(7) and 215(d)(3) of the Social Security Act (Act) require the Social Security Administration (SSA) to use a modified benefit formula to compute Social Security retirement or disability benefits for persons first eligible (after 1985) for both a Social Security benefit and a pension or annuity, based on employment not covered by Social Security. This method is the Windfall Elimination Provision (WEP). SSA makes a determination regarding whether the WEP is applicable and when to apply it to a person’s benefit.
2. Description of Collection
SSA uses Form SSA-58 to verify the claimant's statements about employment on Form SSA-150 (OMB #0960-0395, Modified Benefits Formula Questionnaire). SSA also uses Form SSA-58 to determine if the modified benefit formula is applicable and when to apply it to a person’s benefits. SSA sends Form SSA-58 to an employer for pension-related information, if the claimant is unable to provide it. The respondents are employers of people who are eligible after 1985 for both Social Security benefits and a pension based on work not covered by SSA.
3. Use of Information Technology to Collect the Information
SSA did not create an electronic version of Form SSA-58 under the agency’s Government Paperwork Elimination Act (GPEA) plan because only 30,000 respondents complete the form annually. This is less than the GPEA cut-off of 50,000.
4. Why We Cannot Use Duplicate Information
The nature of the information we collect and the manner in which we collect it preclude duplication. SSA does not use another collection instrument to obtain similar data.
5. Minimizing Burden on Small Respondents
This collection does not affect small businesses or other small entities.
6. Consequence of Not Collecting Information or Collecting it Less Frequently
If we did not use Form SSA-58, we would be unable to determine how to apply the WEP correctly to pay the correct Social Security benefit for claimants whose pension payer did not provide them with the necessary information. Because we collect the information on an as needed basis, we cannot collect it less frequently.
There are no technical or legal obstacles to burden reduction.
Special Circumstance
There are no special circumstances that would cause SSA to conduct this information collection in a manner inconsistent with 5 CFR 1320.5.
8. Solicitation of Public Comment and Other Consultations with the Public
The 60-day advance Federal Register Notice published on February 21, 2017, at
82 FR 11293, and we received no public comments. The 30-day FRN published on April 26, 2017 at 82 FR 1304. If we receive any comments in response to this Notice, we will forward them to OMB.
9. Payment or Gifts to Respondents
SSA does not provide payments or gifts to the respondents.
10. Assurances of Confidentiality
SSA protects and holds confidential the information it collects in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974) and OMB Circular No. A-130.
11. Justification for Sensitive Questions
This information collection does not contain any questions of a sensitive nature.
12. Estimates of Public Reporting Burden
Modality of Completion |
Number of Respondents |
Frequency of Response |
Average Burden per Response (minutes) |
Estimated Total Annual Burden (hours) |
SSA-58 |
30,000 |
1 |
20 |
10,000 |
The total burden for this ICR is 10,000 hours. This figure represents burden hours, and we did not calculate a separate cost burden.
13. Annual Cost to the Respondents (Other)
This collection does not impose a known cost burden on the respondents.
14. Annual Cost To Federal Government
The annual cost to the Federal Government is approximately $46,200. This estimate is a projection of the costs for collecting and processing the information.
15. Program Changes or Adjustments to the Information Collection Request
There are no changes to the public reporting burden.
16. Plans for Publication Information Collection Results
SSA will not publish the results of the information collection.
17. Displaying the OMB Approval Expiration Date
OMB granted SSA an exemption from the requirement to print the OMB expiration date on its program forms. SSA produces millions of public-use forms with life cycles exceeding those of an OMB approval. Since SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis), OMB granted this exemption so SSA would not have to destroy stocks of otherwise useable forms with expired OMB approval dates, avoiding Government waste.
Exceptions to Certification Statement
SSA is not requesting an exception to the certification requirements at
5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).
SSA does not use statistical methods for this information collection.
| File Type | application/msword |
| File Title | December 1998 |
| Author | SSA |
| Last Modified By | Mandley, Tasha |
| File Modified | 2017-05-02 |
| File Created | 2017-02-01 |