SSA-3885

Government Pension Questionnaire

Download and Print the SSA-3885

Request may not be processed if the form is incomplete or illegible.

1. 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 OR ORGANIZATION (Include area code)

2. (a) Enter the last day of employment upon which your pension or annuity is based.
MONTH - DAY - YEAR - State - Federal - Local
(b) On the date shown in (a) above, was this employment covered under Social Security for benefit purposes?
Yes - No

3. (a) What was the first month for which you began receiving your pension or annuity?
MONTH - YEAR
(b) Could you have been eligible for and received this pension or annuity earlier had you stopped working and made application? (If yes, answer (c).)
Yes - No
(c) When could you have first received this pension/annuity?
MONTH - YEAR

4. (a) Did you elect FERS or another covered plan?
Yes - No
If yes, when?
MONTH - YEAR

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.?

And much more...