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1. I request that I be paid directly. CHECK HERE and answer only items 3 5 6 and 8 before signing the form on page 4. I REQUEST THAT THE SOCIAL SECURITY SUPPLEMENTAL SECURITY INCOME BLACK LUNG OR SPECIAL VETERANS BENEFITS FOR THE CLAIMANT S NAMED ABOVE BE PAID TO ME AS REPRESENTATIVE PAYEE* Explain why you think the claimant is not able to handle his/her own benefits. In your answer describe how he/she manages any money he/she receives now. Claimant is a minor child. If you are appointed payee ...

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is an SSA authorization form?

SSA and its affiliated State disability determination services use Form SSA-827, "Authorization to Disclose Information to the Social Security Administration (SSA)" to obtain medical and other information needed to determine whether or not a claimant is disabled.

Who is the number holder on SSA 11 form?

Name of the number holder. Social security number. Name of the person(s) for whom you are filing (claimant) Claimant's social security number.

What is a SSA 4164 form?

3. SSA-4164 (Advance Notification of Representative Payment) The SSA-4164 provides the beneficiary (or legal guardian/representative who can act for the beneficiary) with advance notification of representative payment.

Where can I get form SSA-1099?

If you don't have a My Social Security account, you can call Social Security at 800-772-1213 or visit your local office to request a new SSA-1099 or SSA-1042S.

How do I get Form SSA?

How can I get a form SSA-1099/1042S, Social Security Benefit Statement? Using your personal my Social Security account, and if you don't already have an account, you can create one online. ... Calling us at 1-800-772-1213 (TTY 1-800-325-0778), Monday through Friday, 8:00 am \u2013 7:00 pm.

ssa 11 pdf

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What is ssa11?

Policy. The SSA-11-BK is the paper form a potential payee completes to apply to be payee. Use the paper form only, when it is not possible to use eRPS. For example, we must take paper applications for applicants who do not have a Social Security Number (SSN).

How do I get an SSA form?

What is a SSA 2458 form?

In all other instances, use the Inquiry Response Benefit Verification screen or the paper Form SSA-2458 (Report of Confidential Social Security Benefit Information) to manually generate a BEVE letter or respond to benefit and payment questions.

What is form SSA 787 used for?

Form SSA-787, Physician's/Medical Officer's Statement of Patient's Capability to Manage Benefits, is a form used to determine if a person is able to manage funds or they need a representative payee.

Where can I get the SSA 11 form?

All forms are FREE. Not all forms are listed. If you can't find the form you need, or you need help completing a form, please call us at 1-800-772-1213 (TTY 1-800-325-0778) or contact your local Social Security office and we will help you.

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