Modified Benefit Formula Questionnaire-Employer

SSA collects information on Form SSA-58 to verify the claimant's allegations on Form SSA-150 (OMB#0960-0395, Modified Benefits Formula Questionnaire). SSA uses the SSA-58 to determine if the modified benefit formula is applicable and when to apply it to a person's benefits. SSA sends Form SSA-58 to an employer for pension-related information, if the claimant is unable to provide it. The respondents are employers of people who are eligible after 1985 for both Social Security benefits and a pension based on work not covered by SSA.

The latest form for Modified Benefit Formula Questionnaire-Employer expires 2021-01-31 and can be found here.