Exhibit 3 shows how a SSA-1099 looks when there is Worker’s Compensation Offset and
explains that Social Security benefits potentially subject to tax will include any
workmen's compensation whose receipt caused any reduction in Social Security disability
benefits. For example, if an individual were entitled to $10,000 in Social Security
disability benefits but received only $6,000 because of the receipt of $4,000 of workers’
compensation benefits, then, for the purpose of the provisions taxing Social Security
benefits, the individual will be considered to have received $10,000 of Social Security
benefits.