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164 W. Hospitality Lane, Suite #127
San Bernardino, CA 92408
(909) 4536600PA T I E N T R E G I S T R A T I O N
PATIENT LAST NAME:FIRST:SSN#:How do you wish to be addressed? Date of BirthAddressCityTelephone
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What is 164 w?
Form 164-W, also known as the 'Windfall Elimination Provision (WEP) Request for Review', is a form used by individuals to request a review of how their Social Security benefits might be affected by their past work in jobs not covered by Social Security.
Who is required to file 164 w?
Individuals who have worked in jobs that are not covered by Social Security and believe the Windfall Elimination Provision may apply to them are required to file Form 164-W.
How to fill out 164 w?
To fill out Form 164-W, individuals need to provide personal information including their name, Social Security number, and details about their employment history and earnings. Additionally, they must indicate their request to have their Social Security benefits calculated without the Windfall Elimination Provision.
What is the purpose of 164 w?
The purpose of Form 164-W is to allow individuals to request a review of their Social Security benefit calculations when they may be affected by the Windfall Elimination Provision, ensuring they receive the correct benefit amount.
What information must be reported on 164 w?
Information required on Form 164-W includes the individual's personal information, details of employment not covered by Social Security, and any applicable earnings history relevant to the calculation of benefits.
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