Form SSA-308 (06-2018) UF
Discontinue Prior Editions
Social Security Administration
Page 1 of 3
OMB No. 0960-0561
MODIFIED BENEFIT FORMULA QUESTIONNAIRE - FOREIGN PENSION
NAME OF WAGE EARNER OR SELF-EMPLOYED PERSON
NAME OF PERSON MAKING STATEMENT (if other than above wage earner or self-employed person)
U.S. SOCIAL SECURITY NUMBER
U.S. Social Security retirement or disability benefits may be determined using a different formula under the Windfall Elimination
Provisions (WEP), when you also receive a pension based on employment or self-employment, (employment, meaning work)
from a foreign pension not covered by U.S. Social Security. Social Security benefit amounts use only earnings covered under
Social Security with a benefit formula that gives proportionately higher amounts to workers with low lifetime earnings. A worker
with a substantial period of non-covered work during their lifetime appears to have lower lifetime earnings than they actually had.
WEP reduces the primary insurance amount upon which benefits are based an affects all benefits paid on that record except
survivors. The difference in U.S. Social Security benefits computed under WEP cannot be greater than one-half the amount of
the non-covered pension received in the first month you are entitled to both the non-covered pension and the U.S. Social
Security benefit.
1.
Enter the name and address of the agency or organization
from which you received or expect to receive the pension.
If you receive more than one pension, complete a
separate form for each pension.
NAME
ADDRESS (include postal code)
2.
Is the pension listed in item 1 a partial benefit paid under
a U.S. Social Security (Totalization) agreement?
Yes
If "yes," submit evidence such as an award certificate
or letter from the agency paying the pension, ignore
the rest of the form, and sign your name on the last
page in the appropriate space.
No If "no," complete the rest of the form and sign it.
Unknown
If "unknown," contact the agency paying the
pension for further information about the pension,
complete the form and sign it.
3.
Enter the period(s) of employment or self-employment
upon which your pension is based. Provide specific dates.
Enter a "?" if some information is unknown.
FROM: (MM/DD/YYYY)
TO: (MM/DD/YYYY)
4.
Enter only the period(s) of employment or self-
employment from item 3 above used to determine your
pension which was after 1956 and which was not covered
by U.S. Social Security. Provide specific dates. Enter a
"?" if some information is unknown.
FROM: (MM/DD/YYYY)
TO: (MM/DD/YYYY)
5.
Enter specific periods of voluntary contributions or other
non-employment based credits included in the
computation of your pension. Enter a "?" if some
information is unknown.
FROM: (MM/DD/YYYY)
TO: (MM/DD/YYYY)
6.
Enter the date you first became (or expect to become)
eligible for the pension.
DATE: (MM/DD/YYYY)