Agency/Employer Government Pension Offset Questionnaire

When individuals are concurrently receiving Social Security benefits and a government pension, SSA may reduce the individual's Social Security benefits by the government pension amount; this is called the Government Pension Offset (GPO). SSA uses the SSA-L4163 to collect accurate pension information for purposes of applying the pension offset provision. SSA uses the form only when (1) the claimant does not have the information and (2) the pension-paying agency has not cooperated with the claimant. Respondents are State government or private pension paying agencies that have information needed by SSA to determine if the GPO applies and the amount of offset.

The latest form for Agency/Employer Government Pension Offset Questionnaire expires 2022-10-31 and can be found here.