Social Security Administration Representative Payee Request Form

Submit the SSA-11-BK form as soon as you complete it. You can mail it to your local Social Security office, or you can submit it in person. Find the address of your local office on the Social Security Administration website. Alternatively, you can fax the form to the Social Security Administration. If you have any questions, contact your local Social Security office for assistance. Ensure to attach any required supporting documents and keep a copy of the completed form for your records.

Submit the form as soon as you become a representative payee applicant. Keep track of any deadlines provided by the Social Security Administration for additional documentation or follow-ups in 2024 and 2025.

The purpose of the SSA-11-BK form is to apply to become a representative payee for a Social Security claimant. A representative payee is responsible for managing the benefits of a claimant who is unable to handle their own finances. This form gathers essential information about the claimant and the applicant to ensure the claimant's benefits are managed responsibly. The form requires the applicant to explain why the claimant cannot manage their own benefits and how they will oversee the claimant's needs. By completing this form, the applicant provides the Social Security Administration with a detailed plan for managing the claimant's benefits, ensuring the claimant's well-being. Proper submission and approval of this form is crucial for the responsible management of Social Security benefits.

• 1. Name or Bene. Sym., TOE 250: Field for the name or benefit symbol (TOE 250).
• 2. Date of Birth: Field for the date of birth of the applicant.
• 3. Program Type: Field to specify the type of Social Security program.
• 4. Social Security Number: Field for the Social Security number of the applicant and claimant.
• 5. Explain why you think the claimant is not able to handle his/her own benefits: Field to explain why the claimant cannot manage their own benefits.
• 6. Explain why you would be the best representative payee: Field to describe why the applicant would be the best representative payee.
• 7. Court-appointed legal guardian/conservator: Field to provide information about any legal guardian or conservator.
• 8. Claimant living arrangements: Field to describe the claimant's living arrangements and any expected changes.
• 9. Care for the claimant: Field to specify who takes care of the claimant when the applicant is unavailable.
• 10. Main source of income: Field to provide the main source of income of the applicant.
• 11. Conviction history: Field to provide details of any convictions under federal or state law.

Failing to submit this form can lead to the claimant's benefits being unmanaged, affecting their financial support.

• Unmanaged Benefits: The claimant will not have their Social Security benefits managed.
• Financial Instability: The claimant may experience financial instability without proper management of their benefits.
• Delayed Benefits: There may be delays in receiving benefits as the application process is not completed.

• 1. First-time Application: Submit the form when first applying to be a representative payee.
• 2. Change of Payee: Submit the form when there is a change in the representative payee.
• 3. Legal Guardian Requirement: Submit the form if you are a legal guardian or conservator responsible for managing a claimant's benefits.
• 4. Supporting a Minor: Submit the form if you are responsible for managing the benefits of a minor.
• 5. Organizational Responsibility: Submit the form on behalf of an organization managing client benefits.