OMB control number

Modified Benefit Formula Questionnaire

OMB 0960-0395 ยท SSA.

OMB 0960-0395

SSA collects information on the SSA 150 to determine the correct formula to use in computing the Social Security benefit for someone who receives a pension from employment not covered by Social Security. The Windfall Elimination Provision (WEP) requires use of a benefit formula that replaces a smaller percentage of a worker's pre-retirement earnings. However, the resulting amount cannot show a difference in the benefit computed using the modified and regular formulas greater than one-half the amount of the pension received in the first month an individual is entitled to both the pension and the Social Security benefit. The SSA-150 collects the information needed to make all the necessary benefit computations. SSA requires the respondents to furnish the information on form SSA-150 so we can calculate their benefits using the data they supply. SSA will calculate the benefits of applicants that do not respond to this questionnaire using the full WEP reduction. SSA employees collect this information once from the applicant at the time they file their claim. The respondents are applicants for old age and disability benefits. We are submitting this Change Request to revise requests for pension information as per the Social Security Fairness Act of 2023 (SSFA), which repealed the WEP and Government Pension Offset (GPO) provisions for benefits payable for months after December 2023.

The latest form for Modified Benefit Formula Questionnaire expires 2027-05-31 and is listed under ICR 202503-0960-001.

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202503-0960-001 No material or nonsubstantive change to a currently approved collection 2025-03-14 Approved without change
202410-0960-016 No material or nonsubstantive change to a currently approved collection 2024-10-24
202008-0960-002 Revision of a currently approved collection 2020-08-25
201702-0960-001 Revision of a currently approved collection 2017-04-28 Approved without change
201505-0960-003 No material or nonsubstantive change to a currently approved collection 2015-05-15 Approved without change
201311-0960-013 Revision of a currently approved collection 2014-04-02 Approved without change
201107-0960-008 No material or nonsubstantive change to a currently approved collection 2011-07-26 Approved without change
201010-0960-002 Revision of a currently approved collection 2011-02-04 Approved without change
200712-0960-008 Extension without change of a currently approved collection 2008-02-27 Approved without change
200501-0960-007 Extension without change of a currently approved collection 2005-01-24 Approved without change
200112-0960-006 Extension without change of a currently approved collection 2001-12-05 Approved without change
199811-0960-001 Extension without change of a currently approved collection 1998-11-13 Approved without change
199511-0960-008 Extension without change of a currently approved collection 1995-11-05 Approved without change
199209-0960-001 Revision of a currently approved collection 1992-09-16 Approved without change
198908-0960-005 Revision of a currently approved collection 1989-08-15 Approved without change
198611-0960-001 Extension without change of a currently approved collection 1986-11-04 Approved without change
198503-0960-005 New collection (Request for a new OMB Control Number) 1985-03-13 Approved without change