Program Operations Manual System (POMS)
RM 03253.001 Schedule SSA (Annual Registration Statement Identifying Separated Participants With
Deferred Vested Benefits
The Schedule SSA is completed by the representative of a private pension plan, employer
or Plan Administrator, and submitted to IRS as part of a report (Form 5500, Annual
Return/Report of Employee Benefit plan). IRS forward the Schdules SSA to the Social
Security Administration. See Exhibit 1.
The following information is submitted on the front side of Schedule SSA:
Sponsor/Employer's name, address and EIN.
Plan Administrator's name, address, and employer identification number.
Plan participant's identifying and deferred vested benfits information:
Type of Annuity (e.g., single sum, life annuity, etc.).
Payment Frequency (e.g., monthly, quarterly, etc.).
Periodic Payment (amount to be paid monthly, annually, etc.).
NOTE: Periodic Payment applies to Defined Benefit Plans only. An example of a defined benefit
plan is the civil service retirement plan for SSA employees.
Units or Share (Total number of units or shares held at the time of separation).
NOTE: Unitsthe number of units will be shown. Sharesthe number of shares will be shown
together with the “S” to indicate shares.
Total Value of Account (Total money value of units or shares held at the time of separation).
NOTE: Units or Share and Total Value of Account apply to Defined contribution Plans only,
e.g., a profit sharing plan.
Item number 6 provides for the reporting of plan participant (and subsequent change
or removal from SSA records) information for individuals who have received part or
all of their vested benefits from a specific pension plan.
The Reverse side of the form provides more detailed information and an explanation
of the pension information funished.
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RM 03253.001 - Schedule SSA (Annual Registration Statement Identifying Separated Participants With Deferred Vested Benefits - 12/20/1989
Batch run: 12/20/1989