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Ear 2001 or tax year beginning , 2001, and ending , 20 Name Number, street, and room or suite no. (If a P.O. box, see page 4.) Use IRS label. Otherwise, please print or type. Employer identification number (see page 4) Date association formed City or town, state, and ZIP code Check if: (1) Final return (2) Name change (3) Condominium management association A Check type of homeowners association: B C D E Address change (4) Residential real estate association B Total exempt function inco.

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§ 416.622 Who may not serve as a representative payee? A representative payee applicant may not serve if he/she: (a) Has been convicted of a violation under section 208, 811 or 1632 of the Social Security Act. (b) Has been convicted of an offense resulting in imprisonment for more than 1 year.

Representative payees can fill out the form and return it to Social Security by mail, or conveniently file it online at .ssa.gov/myaccount/rep-payee.html. Organizational representative payees are able to complete their Representative Payee Report online by using Business Services Online.

This report is about the benefits you received between and for the beneficiary, . Please read the enclosed instructions before completing this form to help you answer each question. 1.

You may receive a Representative Payee Report form for you to account for the Social Security or SSI benefits received or we may select you for a representative payee review. The review is to determine if you have performed the following duties: Managed funds so the beneficiary(ies) have no unmet current needs.

You must complete form SSA-11 (Request to be selected as payee) and show us documents to prove your identity. You will need to provide your social security number, or if you represent an organization, the organization's employer identification number.

Form SSA-623 requires the representative payee to account for all benefit funds issued within a particularly time period. The SSA sends notices for this form to be completed on an intermittent schedule.

To complete an SSA 11-BK, you will need to provide the following information: Name of the number holder. Social security number. Name of the person(s) for whom you are filing (claimant) Claimant's social security number. Indication if you are the claimant and what your benefits paid directly to you.

Social Security's Representative Payment Program provides benefit payment management for our beneficiaries who are incapable of managing their Social Security or Supplemental Security Income (SSI) payments.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232