View Information Collection Request (ICR) Package

OMB Control No: 0960-0395	ICR Reference No: 201505-0960-003
Status: Historical Active	Previous ICR Reference No: 201311-0960-013
Agency/Subagency: SSA	Agency Tracking No:
Title: Modified Benefit Formula Questionnaire
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/14/2015
	Date Received in OIRA: 05/15/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2017	06/30/2017	06/30/2017
Responses	90,000	0	90,000
Time Burden (Hours)	12,000	0	12,000
Cost Burden (Dollars)	0	0	0

Abstract: SSA collects information on the SSA 150 to determine the correct formula to use in computing the Social Security benefit for someone who receives a pension from employment not covered by Social Security. The Windfall Elimination Provision (WEP) requires use of a benefit formula that replaces a smaller percentage of a worker's pre-retirement earnings. However, the resulting amount cannot show a difference in the benefit computed using the modified and regular formulas greater than one-half the amount of the pension received in the first month an individual is entitled to both the pension and the Social Security benefit. The SSA-150 collects the information needed to make all the necessary benefit computations. SSA requires the respondents to furnish the information on form SSA-150 so we can calculate their benefits using the data they supply. SSA will calculate the benefits of applicants that do not respond to this questionnaire using the full WEP reduction. SSA employees collect this information once from the applicant at the time they file their claim. The respondents are applicants for old age and disability benefits. This is a non-substantive Change Request to add a new, fillable modality.

Authorizing Statute(s): US Code: 42 USC 415 Name of Law: Social Security Act

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 76378	12/17/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 17632	03/28/2014
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Modified Benefit Formula Questionnaire	SSA-150

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	90,000	90,000
Annual Time Burden (Hours)	12,000	12,000
Annual Cost Burden (Dollars)	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

Annual Cost to Federal Government: $138,600

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov

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