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MODIFIED BENEFIT FORMULA QUESTIONNAIRE - …

Form SSA-308 (06-2018) UF. Discontinue Prior Editions Page 1 of 3. Social Security Administration OMB No. 0960-0561. MODIFIED BENEFIT FORMULA QUESTIONNAIRE - FOREIGN PENSION. NAME OF WAGE EARNER OR SELF-EMPLOYED PERSON SOCIAL SECURITY NUMBER. NAME OF PERSON MAKING STATEMENT (if other than above wage earner or self-employed person). 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).

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

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