Form SSA-1945 Statement Concerning Your Employment in a Job Not Covered by Social Security

What Is Form SSA-1945?

Form SSA-1945, Statement Concerning Your Employment in a Job Not Covered by Social Security is a form used for providing an explanation of how the present employment can affect future Social Security benefits of the employee. It is required to fill out and submit this form when you take any job for which you do not pay Social Security tax.

The form - also known as SSA Form 1945 - was issued by the Social Security Administration (SSA). The latest version of the document was released in January 2013 with previous editions obsolete. An SSA-1945 fillable form is available for download and digital filing below.

If you are an employer and need paper copies of the document, you can request them from the SSA by email or fax. Indicate your full name, address, and telephone number. You may also provide the name of the person these documents will be delivered to. The forms are sent in packages of 25. The documents will not be delivered to a post office box.

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Social Security Administration
Statement Concerning Your Employment in a Job
Not Covered by Social Security
Employee Name
Employee ID#
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
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 2013, the maximum monthly reduction in your Social Security benefit as
a result of this provision is $395.50. This amount is updated annually. This provision reduces, but does not
totally eliminate, your Social Security benefit. For additional information, please refer to Social Security
Publication, “Windfall Elimination Provision.”
Government Pension Offset Provision
Under the Government Pension Offset Provision, 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 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 Form SSA-1945 that contains information about the possible effects of the
Windfall Elimination Provision and the Government Pension Offset Provision on my potential future
Social Security Benefits.
Date
Signature of Employee
Form SSA-1945 (01-2013)
Destroy Prior Editions
Social Security Administration
Statement Concerning Your Employment in a Job
Not Covered by Social Security
Employee Name
Employee ID#
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
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 2013, the maximum monthly reduction in your Social Security benefit as
a result of this provision is $395.50. This amount is updated annually. This provision reduces, but does not
totally eliminate, your Social Security benefit. For additional information, please refer to Social Security
Publication, “Windfall Elimination Provision.”
Government Pension Offset Provision
Under the Government Pension Offset Provision, 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 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 Form SSA-1945 that contains information about the possible effects of the
Windfall Elimination Provision and the Government Pension Offset Provision on my potential future
Social Security Benefits.
Date
Signature of Employee
Form SSA-1945 (01-2013)
Destroy Prior Editions
Information about Social Security Form SSA-1945 Statement Concerning Your
Employment in a Job Not Covered by Social Security
New legislation [Section 419(c) of Public Law 108-203, the Social Security Protection Act of 2004] requires
State and local government employers to provide a statement to employees hired January 1, 2005 or later in a
job not covered under Social Security. The statement explains how a pension from that job could affect future
Social Security benefits to which they may become entitled.
Form SSA-1945, Statement Concerning Your Employment in a Job Not Covered by Social Security, is
the document that employers should use to meet the requirements of the law. The SSA-1945 explains the
potential effects of two provisions in the Social Security law for workers who also receive a pension based on
their work in a job not covered by Social Security. The Windfall Elimination Provision can affect the amount of a
worker’s Social Security retirement or disability benefit. The Government Pension Offset Provision can affect a
Social Security benefit received as a spouse, surviving spouse, or an ex-spouse.
Employers must:
Give the statement to the employee prior to the start of employment;
Get the employee’s signature on the form; and
Submit a copy of the signed form to the pension paying agency.
Social Security will not be setting any additional guidelines for the use of this form.
Copies of the SSA-1945 are available online at the Social Security website,
www.socialsecurity.gov/online/ssa-1945.pdf. Paper copies can be requested by email at
ofsm.oswm.rqct.orders@ssa.gov or by fax at 410-965-2037. The request must include the name, complete
address and telephone number of the employer. Forms will not be sent to a post office box. Also, if
appropriate, include the name of the person to whom the forms are to be delivered. The forms are available in
packages of 25. Please refer to Inventory Control Number (ICN) 276950 when ordering.
Form SSA-1945 (01-2013)

Download Form SSA-1945 Statement Concerning Your Employment in a Job Not Covered by Social Security

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How to Use Form SSA-1945?

Employers are obliged to use the Social Security Form SSA-1945 to fulfill the requirements of the U.S. law. The document states that the employee's earnings from this job are not covered under Social Security. Besides, it contains an explanation of provisions in the Social Security law for the employees who receive a pension based on a job not covered under Social Security.

There are two such provisions:

  • Windfall Elimination Provision;
  • Government Pension Offset Provision.

The first one affects the calculations of your retirement or disability benefits. If your employer does not withhold from your salary Social Security taxes, any retirement or disability pension based on this job can reduce the amount of Social Security benefits you may be entitled to.

According to the second, if you are entitled to receive a federal, state, or local government pension based on the job you did not pay Social Security taxes for, any Social Security spouse or widow(er) benefits you become entitled will be offset. Thus, the amount of your Social Security payments will be reduced by two-thirds of the amount of your pension.

An SS employer has to provide you with a SSA-1945 for reading and signing, to make sure you are fully aware of the potential effect of these provisions on your future Social Security benefits. The document also contains examples of possible monthly reductions of the Social Security benefits, formulas, according to which you can calculate the potential reductions, and toll-free phone numbers you can call for any additional information.

Form SSA-1945 Instructions

General filing instructions are as follows:

  1. The employer is obliged to provide you with the Form SSA-1945 before the employment starts;
  2. You must read the form carefully. If something is unclear or you have further questions, contact the nearest SSA office or call the number provided on the form. The SSA officials can also inform you about exceptions to each provision;
  3. Print your name and ID at the top of the form;
  4. You may be required to print the name and ID of your employer too in some cases;
  5. Sign the form and provide the date in the applicable fields at the bottom of the page;
  6. Make a copy of the document for future references;
  7. Return the completed form to your employer.

The employer will submit a copy of the signed form to the pension paying agency.

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