REQUEST TO BE SELECTED AS PAYEE
as payee form approved social security administration toe 250 omb no. 0960-0014 print in ink: i request that the social security, supplemental security income, or special veterans benefits for the claimant(s) named above be paid to me as representative payee. form ssa-11-bk (08-2009) ef (08-2009) destroy prior editions page 1 for ssa use only ...
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