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WHOSE Records to be Disclosed First Middle NAME SSN Form Approved OMB No. 0960-0623 Last SSA USE ONLY NAME SSN Birthday (mm/dd/by) NUMBER HOLDER (If other than above) ** PLEASE READ THE ENTIRE FORM,
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OMB No. 0960-0623 refers to the form titled 'Representative Payee Report' which is used by individuals who are designated as representative payees for Social Security or Supplemental Security Income (SSI) recipients to report on how they used and managed the beneficiary's funds.
Individuals who have been appointed as representative payees for Social Security or Supplemental Security Income (SSI) recipients are required to file OMB No. 0960-0623, the Representative Payee Report.
To fill out OMB No. 0960-0623, the Representative Payee Report, the appointed representative payee must provide information regarding the income and expenses of the beneficiary, any changes in the beneficiary's residence or institutionalization, and details about the management of the funds received for the beneficiary. The form can be completed electronically or manually and should be submitted to the Social Security Administration.
The purpose of OMB No. 0960-0623, the Representative Payee Report, is to ensure that representative payees are responsibly managing and using the funds received on behalf of the Social Security or Supplemental Security Income (SSI) beneficiaries. It helps to monitor the welfare of the beneficiaries and prevents any potential mismanagement or misuse of funds.
On OMB No. 0960-0623, the Representative Payee Report, the representative payee must report information such as the beneficiary's income, expenses, changes in living arrangements, medical or institutionalization information, and details about how the funds were managed and used for the beneficiary during the reporting period.
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