Form Ssa 45 PDF Details

Form Ssa 45 is a form that you use to report the wages and tips you received from your employer in the previous year. This form is used to determine your Social Security benefits, so it's important that you complete it accurately. In this blog post, we'll walk you through how to complete Form Ssa 45. We'll also provide some tips for ensuring that your information is correct.

Listed below are some details you might like to review before using the form ssa 45.

Form NameForm Ssa 45
Form Length2 pages
Fillable fields1
Avg. time to fill out42 sec
Other namessf 45 form ssa, blank ssa 45 bk, ssa 45 blank, ssa 45 examples

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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 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.

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, Paper copies can be requested by email at 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)

How to Edit Form Ssa 45 Online for Free

The PDF editor was made with the goal of allowing it to be as simple and user-friendly as it can be. The next steps will help make filling out the form ssa 45 bk 04 2012 simple.

Step 1: At first, click the orange "Get form now" button.

Step 2: Now you should be on the file edit page. You can include, update, highlight, check, cross, add or erase areas or text.

To be able to prepare the document, enter the details the application will ask you to for each of the next parts:

completing ssa 45 f5 stage 1

Write down the expected particulars in the space Signature, of, Employee FormS, S, A, Destroy, Prior, Editions and Date.

step 2 to finishing ssa 45 f5

Jot down the significant information in section.

ssa 45 f5  fields to fill

Step 3: As soon as you are done, click the "Done" button to transfer your PDF form.

Step 4: Get at least several copies of the document to keep clear of any specific possible difficulties.

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