TN 2 (06-96)
NL 00901.010 ERISA Notice
In 1979, the Social Security Administration (SSA) began providing notices of potential private pension eligibility to title II applicants as required by the ERISA Act of 1974.
The Wilkes Barre DOC keys information from the Schedule A of Form 5500, Annual Return/Report of Employee Benefit Plan, sent to SSA by the Internal Revenue Service to create the Private Pension Employer Master File (PPEMF). Once a month, SSA matches the file of applicants for Social Security benefits against the PPEMF. When a match occurs, SSA sends the Form SSA-L99-C1 to persons potentially eligible for private pensions. Also, upon request, SSA will provide an SSA-L99-C1 to those potentially eligible for private pensions.
Social Security Administration
Potential Private Pension Benefit Information
Social Security Number
We are writing to tell you that you, or the worker whose Social Security number appears at the top of this form, MAY be entitled to some private pension benefits upon retirement. Also, your family, or the worker's family, may be entitled to retirement or survivor benefits.
These Are Not Social Security Benefits
These potential benefits are NOT Social Security benefits and we do not make any decisions about the payment of these benefits. The following provides some basic information about these private pension benefits.
Information About Pension Benefits
You have, or the worker has, earned pension rights although no longer employed in a job covered by the pension plan. These are called “deferred vested benefits.” Private pension plan administrators must provide information about such benefits to us through the Internal Revenue Service. We provide this information about the pension plan when the individual asks for it or when a claim is filed for Social Security benefits.
If You Want to Apply for These Benefits
If you want to apply for these pension benefits or have any questions, you should contact the pension Plan Administrator shown below. Include the 9 digit identification number shown below and a copy of this notice when you write to the Plan Administrator.
Plan Name Plan Number
Year Reported Estimated Amount
Plan Administrator and Address Type of Annuity Payment Frequency
Units or Share Value of Account
IMPORTANT: This is all the information we have. See the other side of this page for an explanation of this information
For SSA Use Only: Form SSA-L99-C1 (1-91) (Front)
EXPLANATION OF INFORMATION
|This is the year for which the Plan Administrator reported the pension plan information to the Internal Revenue Service. |
|This is the Plan Administrator's estimate of pension benefits that may be paid at the normal retirement age. The actual method and/or amount of payment may differ because of benefit options you select or changes in the plan itself. |
|The code listed identifies the type of annuity to be paid. It is based on the type of annuity in use under the plan at the time the worker stopped working under the plan. |
A single payment of a lump sum
Annuity payable over a fixed number of years
Life annuity with period certain
Cash refund life annuity
Modified cash refund life annuity
Joint and last survivor annuity
Other (Type of annuity not reported)
|The code listed shows how often payments will be made during a 12 month period. |
Other (Payment frequency not reported)
|If the pension amount is based on units, the number of units credited will be shown. If the pension amount is based on shares of stock, the number of shares will be shown followed by “S” to indicate shares. |
|If shown, this indicates the value of the account at the time the worker stopped working under the plan. |
OTHER IMPORTANT INFORMATION
|If the pension plan address on page 1 proves to be wrong, or if you have a complaint about your claim for private pension benefits, you should contact the local office of the Department of Labor's Pension and Welfare Benefits Administration that is listed in your local telephone directory. If there is no listing in the local directory, you should write to the Department of Labor, Pension and Welfare Benefits Programs, Room 4659, 3rd Street and Constitution Avenue N.W., Washington, DC 20216.|
Form SSA-L99-C1 (1-91)(Back)