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SSA POMS GN 00502.115 The SSA11BK, Request to be Selected As
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Date of your last medical disability decision: I request that i be paid directly. Please read this information before completing this report. 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. You can include text or manage present data.
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Follow the simple instructions below: Request to be selected as payee (social security administration) form is 4 pages long and contains: Request to be selected as payee. Social security administration staff or others who help people apply for ssi will fill out this form for you.
Program Date Of Birth Type Gdn.
Request to be selected as payee. Use the paper form only, when it is not possible to use erps. Fill out the request to be selected as payee online and print it out for free. Application for supplemental security income (ssi) note:
Check Here And Answer Only Items 3, 5, 6, And 8 Before Signing The Form On Page 4.
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. Web check here and answer only items 3, 5, 6, and 8 before signing the form on page 4. Date of your last medical disability decision: If not currently married, write none. go on to item 14(b).