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ADVANCE DIRECTIVE FORM Part One: Designation of Health Care Surrogate Name: (Last) (First) (Middle Initial) In the event that I have been determined to be incapacitated to provide informed consent
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Part one designation is a form used to designate a representative payee for Social Security benefits.
Individuals who are applying to become a representative payee for someone receiving Social Security benefits are required to file part one designation.
Part one designation can be filled out online or by visiting a local Social Security office. The form requires basic personal information and details about the relationship to the beneficiary.
The purpose of part one designation is to ensure that Social Security benefits are being managed by a responsible individual on behalf of the beneficiary.
Information such as the representative payee's name, address, relationship to the beneficiary, and any legal guardianship status must be reported on part one designation.
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