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Get SSA-623-OCR-SM 2012

EPORT PERIOD FROM: TO: FP BENEFICIARY ID TP TAA CF If change at' address, check box and enter new address on back of report. D BIC CC GS PC DOC BSSN PF 0 This report is about the benefits you received between and for the beneficiary, . Please read the enclosed instructions before completing this fonn to help you answer each question. 1. 2. 3. YES Benefits paid to you between and Benefits you reported as saved on last year's report. =$ .. .. .. Did you (the saved? A • If .

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