Statement Concerning Your Employment in a Job
Not Covered by Social Security
_______________________________________________________________________________________________________________________
Employee Name Employee SS#
_______________________________________________________________________________________________________________________
Employer Name Employer ID#
Your earnings from this job are not covered under Social Security. When you retire, or if you become disabled, you may
receive a pension based on earnings from this job. If you do, and you are also entitled to a benefit from Social Security
based on either your own work or the work of your husband or wife, or former husband or wife, your pension may affect
the amount of the Social Security benefit you receive. Your Medicare benefits, however, will not be affected. Under the
Social Security law, there are two ways your Social Security benefit amount may be affected.
Windfall Elimination Provision (WEP)
Under the Windfall Elimination Provision, your Social Security retirement or disability benefit is figured using a modified
formula when you are also entitled to a pension from a job where you did not pay Social Security tax. As a result, you will
receive a lower Social Security benefit than if you were not entitled to a pension from this job. For example, if you are age
62 in 2005, the maximum monthly reduction in your Social Security benefit as a result of this provision is $313.50. This
amount is updated annually. This provision reduces, but does not totally eliminate, your Social Security benefit. For
additional information, please refer to the Social Security publication, “Windfall Elimination Provision.”
Government Pension Offset (GPO)
Under the Government Pension Offset, any Social Security spouse or widow(er) benefit to which you become entitled will
be offset if you also receive a federal, state, or local government pension based on work where you did not pay Social
Security tax. The offset reduces the amount of your Social Security spouse or widow(er) benefit by two-thirds of the amount
of your pension.
For example, if you get a monthly pension of $600 based on earnings that are not covered under Social Security, two-thirds
of that amount, $400, is used to offset your Social Security spouse or widow(er) benefit. If you are eligible for a $500
widow(er) benefit, you will receive $100 per month from Social Security, $500 – $400 = $100. Even if your pension is high
enough to totally offset your spouse or widow(er) Social Security benefit, you are still eligible for Medicare at age 65. For
additional information, please refer to the Social Security publication, “Government Pension Offset.”
For more information
Social Security publications and additional information, including information about exceptions to each provision, are
available at www.socialsecurity.gov. You may also call toll free 1-800-772-1213, or, for the deaf or hard of hearing, call the
TTY number 1-800-325-0778, or contact your local Social Security office.
I certify that I have received TRSL Form 2SS (Form SSA-1945) that contains information about the possible effects
of the Windfall Elimination Provision (WEP) and the Government Pension Offset (GPO) on my potential future
Social Security benefits.
_______________________________________________________________________________________________________________________
_____________ / _____________ / _____________________
Signature of Employee Date (mm-dd-yyyy)
Form SSA-1945 (11-2004) (Expires January 2006)
Teachers’ Retirement System of Louisiana
8401 United Plaza Blvd, Ste 300 • Baton Rouge, LA 70809-7017
PO Box 94123 • Baton Rouge, LA 70804-9123
Telephone: (225) 925-6446 • Fax: (225) 925-4258
www.trsl.org
Form 2SS (01/05)
(Form SSA-1945)
00-2SS
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