Ssa 3885 Form – Fill Out and Use This PDF

The Form SSA-3885, known as the Government Pension Questionnaire, is a document used by the Social Security Administration (SSA) to determine the impact of a government pension on Social Security benefits. This form collects various details including the pensioner's employment history, the pension received, and any changes in pension amounts that might affect Social Security benefits. Providing accurate and complete information on the form is crucial as it helps ensure the correct calculation of Social Security benefits and prevents potential overpayments. Click the button below to start filling out your SSA-3885 form accurately and ensure your Social Security benefits are assessed correctly.

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Ssa 3885 Form PDF Details

The Social Security Administration (SSA) employs a comprehensive approach when it comes to determining the impact of governmental pensions on Social Security benefits, and the SSA-3885 form, known as the Government Pension Questionnaire, plays a pivotal role in this process. Embedded within this multi-faceted form are queries tailored to glean crucial information about the pensioner, including the specifics of the pension or annuity received – be it from local, state, or federal levels. The form requests detailed inputs such as the pension's starting date, whether the employment was covered under Social Security, and information on the pension amount before and after deductions. Significantly, it probes into whether the pension or annuity influences the claimant's Social Security benefits, a factor contingent upon the intricate rules that intersect pensions with Social Security entitlements. Moreover, the form underlines the importance of transparency and accuracy in the provision of information, alerting the claimant to the repercussions of false statements. It emphasizes the necessity of promptly reporting any changes in pension amounts to avert potential overpayments. Through the SSA-3885 form, the administration seeks to ensure an accurate and timely adjudication of Social Security benefit claims, while providing a clear conduit for individuals to communicate their pension details, thus fostering a fair assessment of their entitlements.

Question	Answer
Form Name	Ssa 3885 Form
Form Length	3 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	45 sec
Other names	ssa3885, government questionnaire download, form ssa3885, government pension questionnaire

Form Preview Example

Paperwork Reduction Act Statement

	Form SSA-3885 (02-2018) UF
	Discontinue Prior Editions	Page 1 of 3
	Social Security Administration	OMB No. 0960-0160

	Government Pension Questionnaire

	Name of Wage Earner or Self-Employed Person	Social Security Number

	Name of Person Making Statement (If other than wage earner or self-employed person)	Relationship to Wage Earner or
		Self-Employed Person
		Self-Employed Person

Privacy Act Statement - Collection and Use of Personal Information

Section 202(k)(5) of the Social Security Act, as amended, allows us to collect this information. Furnishing us this information is voluntary. However, failing to provide all or part of the information may prevent an accurate and timely decision on your claim and could affect your Social Security benefit. We will use the information to determine the effect of your pension on your Social Security benefit. We may also share the information for the following purposes, called routine uses: 1. To contractors and other Federal agencies, as necessary, for the purpose of assisting SSA in the efficient administration of its programs; and, 2. To student volunteers, individuals working under a personal services contract, and other workers who technically do not have the status of Federal employees, when they are performing work for SSA, as authorized by law, and they need access to personally identifiable information in SSA records in order to perform their assigned Agency functions. In addition, we may share this information in accordance with the Privacy Act and other Federal laws. For example, where authorized, we may use and disclose this information in computer matching programs, in which our records are compared with other records to establish or verify a person’s eligibility for Federal benefit programs and for repayment of incorrect or delinquent debts under these programs. A list of additional routine uses is available in our Privacy Act System of Records Notices (SORNs) 60-0089, entitled Claims Folders Systems and

60-0090, entitled Master Beneficiary Record. Additional information and a full listing of all our SORNs are available on our website at www.socialsecurity.gov/foia/bluebook.

- This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control number. We estimate that it will take about 12.5 minutes to read the instructions, gather the facts, and answer the questions. SEND OR BRING THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE.

You can find your local Social Security office through SSA’s website at www.socialsecurity.gov. Offices are also listed under U. S. Government agencies in your telephone directory or you may call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). You may send comments on our time estimate above to: SSA, 6401Security Blvd, Baltimore, MD 21235-6401. Send only comments relating to our time estimate to this address, not the completed form.

Enter the name and address of the agency or organization below from which your government pension or annuity is received:

Name of Agency or Organization	Address of Agency or Organization	Phone Number of Agency
		Phone Number of Agency
		or Organization (Include
		area code)

(a) Enter the last day of employment upon which your pension or annuity is based.

State

Federal

Local

(b)On the date shown in (a) above, was this employment covered under Social Security for benefit purposes?

(a)What was the first month for which you began receiving your pension or annuity?

(b)Could you have been eligible for and received this pension or annuity earlier had you stopped working and made an application? (If yes, answer (c).)

(c)When could you have first received this pension/annuity?

(a)Did you elect FERS or another covered plan? If yes, when?

Month	Day	Year

Yes	No

Month	Year

Yes	No

Month	Year

Yes	No

Month	Year

Form SSA-3885 (02-2018) UF

Page 2 of 3

5.(a) Do you receive your pension/annuity weekly, biweekly, or monthly?

	What is the current pension amount after any deductions made to provide for a survivor	$
	annuity, but before any deductions for health insurance, allotments, bonds, etc.?

(b) Did you elect a lump sum payment with a reduced annuity?		Yes	No

	If yes, what is the amount of the annuity before reduction for the lump sum?	$

(c) Did you elect an annuity in one lump sum payment?		Yes	No

	If yes, what is the amount?	$
	What was the specific period of time for which the lump sum payment was made?


(d) Has your pension amount changed for any months for which you are applying or have		Yes	No
	been receiving spouse's or surviving spouse's Social Security benefits?	Yes	No


	If yes, give the former amount(s) and date(s) of change below:	Date(s) of Change

	Former Amount(s)	Month	Year

$

$

$

If the date in either 3(a) or 3(c) is before 7/1/83, answer item 6.

6.(a) Were you receiving at least one half support from your spouse at the time your spouse became entitled to retirement or disability insurance benefits (or stopped work prior to disability), or if you are a widow or widower at the T IM E your spouse died?

(b)Have you filed proof of such support with the Social Security Administration?

Remarks

Yes	No
(If yes, answer (b).)

Yes	No

Form SSA-3885 (02-2018) UF	Page 3 of 3

Important Information - Please Read the Following Carefully and Then Sign Below

I agree to promptly report to the Social Security Administration if the amount of my present pension or annuity changes. I understand that my pension or annuity may affect my Social Security benefits and that failure to report such pension or annuity may result in an overpayment which I may have to pay back.

I know that anyone who makes or causes to be made a false statement or representation of material fact in an application or for use in determining a right to payment under the Social Security Act commits a crime punishable under Federal law by fine, imprisonment or both. I affirm that all information I have given in this document is true.

Signature of Person Making Statement

Signature (First name, middle initial, last name) (Write in ink)

Mailing Address (Number and street, Apt. No., P.O. Box, Rural Route)

City and State

Date (Month, Day, Year)

Telephone number(s) at which you may be contacted during the day (Include area code)

ZIP Code

Witness are required ONLY if this statement has been signed by mark (X) above. If signed by mark (X), two witness to the signing who know the individual must sign below giving their full address.

Signature of Witness

Address (Number and Street, City, State, and ZIP Code)

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1. Whenever filling out the pension person form, ensure to complete all of the necessary blank fields within the corresponding form section. It will help hasten the work, allowing for your details to be handled without delay and appropriately.

2. The next stage is to fill in these particular fields: Name of Agency or Organization, Address of Agency or Organization, Phone Number of Agency or, a Enter the last day of employment, Month, Day, Year, State, Federal, Local, b On the date shown in a above was, for benefit purposes, Yes, a What was the first month for, and Month.

The right way to complete 3885 ssa portion 2

Always be very attentive while filling out Yes and Month, because this is where most users make mistakes.

3. This next portion will be about Form SSA UF, Page of, a Do you receive your, What is the current pension amount, b Did you elect a lump sum payment, If yes what is the amount of the, c Did you elect an annuity in one, If yes what is the amount, What was the specific period of, d Has your pension amount changed, been receiving spouses or, If yes give the former amounts and, Former Amounts, Yes, and Yes - fill in each one of these empty form fields.

4. This section comes with these particular fields to focus on: If the date in either a or c is, a Were you receiving at least one, spouse became entitled to, Yes, If yes answer b, b Have you filed proof of such, Yes, and Remarks.

5. And finally, the following final subsection is what you'll want to wrap up prior to using the document. The blanks in question include the next: Signature First name middle, Date Month Day Year, Mailing Address Number and street, Telephone numbers at which you may, City and State, ZIP Code, Witness are required ONLY if this, Signature of Witness, Signature of Witness, Address Number and Street City, and Address Number and Street City.

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Ssa 3885 Form – Fill Out and Use This PDF

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