Form SSA-150 Modified Benefit Formula Questionnaire

Modified Benefit Formula Questionnaire

SSA-150 (revised)

Modified Benefit Formula Questionnaire

OMB: 0960-0395

Document [pdf]
Download: pdf | pdf
(12-2024)

MODIFIED BENEFIT FORMULA QUESTIONNAIRE
(Complete this form only if you received a non-covered pension prior to January 2024)

4. Enter the date you became eligible for a non-covered
pension.
5. Enter the pension entitlement start and end date
(if pension entitlement ended in the past) for a non-covered
pension.
6.

7.

MM/YYYY
From: (MM/YYYY) To: (MM/YYYY)

(12-2024)


File Typeapplication/pdf
AuthorOAESP
File Modified2025-03-14
File Created2025-03-13

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