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Get SSA-11-BK 2006

O BE SELECTED A S PAYEE DISTRICT OFFICE CODE STATE AND COUNTY CODE: PRINT IN INK: The name o f the NUMBER HOLDER SOCIAL SECURITY NUMBER The name of the PERSON(S) (if different from above) for w h o m you are filing (the "claimant(s)") SOCIAL SECURITY NUMBERE) Answer item 1 ONLY if you are the claimant and want your benefits paid directly to you. 1. I request that I be paid directly. 1 CHECK HERE and answer only items 3, 5, 6, and 8 before signing the form on page 4. I REQUEST THAT THE .

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