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Form 1945, Statement Concerning Your Employment in a Job Not Covered by Social Security, Issued (PDF)
U.S. Social Security Administration [SSA] 
Dec. 20, 2004
Effective January 1, 2005, the form is to be given to newly hired employees of state or local governments that do not pay Social Security taxes, who must then sign the form to indicate their understanding of its provisions. The form explains the extent to which the Windfall Elimination Provision and the Government Pension Offset Provision apply to employees in this situation, potentially reducing their ultimate Social Security benefits.
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