REQUEST TO BE SELECTED AS PAYEE

Form SSA-11-BK (01-2014) EF (01-2014) Use (08-2009) EF (08-2009) edition until exhaustedSOCIAL SECURITY ADMINISTRATIONREQUEST TO BE SELECTED AS PAYEEForm Approved OMB No. 0960-0014 Page 1 TOE 250 FOR SSA USE ONLYName or Bene. of OFFICE CODESTATE AND COUNTY CODEPRINT IN INK:The name of the NUMBER HOLDERSOCIAL SECURITY NUMBERThe name of the PERSON(S) (if different from above) for whom you are filing (the "claimant(s)")SOCIAL SECURITY NUMBER(S)Answer item 1 ONLY if you are the claimant and want your benefits paid directly to REQUEST that I be paid HEREand answer only items 3, 5, 6, and 8 before signing the form on page REQUEST THAT THE SOCIAL SECURITY, SUPPLEMENTAL SECURITY INCOME, OR SPECIAL VETERANS BENEFITS FOR THE CLAIMANT(S) NAMED ABOVE BE PAID TO ME AS REPRESENTATIVE why you think the claimant is not able to handle his/her own benefits.

Form SSA-11-BK (01-2014) EF (01-2014) Use (08-2009) EF (08-2009) edition until exhausted SOCIAL SECURITY ADMINISTRATION REQUEST TO BE SELECTED AS

Loading..

Tags:

  Request, Selected, Payee, Request to be selected as payee, Request to be selected as

Information

Related search queries