SSA Form SSA-159 2017-2026 free printable template
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Attachment 2 Form Approved OMB No 0960-0757 Social Security Administration GSO Website Registration Form Complete the following information to obtain access to GSO services.
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How to fill out SSA Form SSA-159
How to fill out SSA Form SSA-159
01
Obtain the SSA Form SSA-159 from the Social Security Administration's website or your local SSA office.
02
Fill out your personal information in Section A, including your name, Social Security number, and address.
03
In Section B, list the details of the services you received that require reimbursement.
04
Fill in the requested amounts in Section C, specifying the fees you are claiming.
05
If applicable, provide the names and addresses of any third-party payers in Section D.
06
Sign and date the bottom of the form to certify that the information provided is accurate.
07
Submit the completed form to the SSA using the instructions provided on the form.
Who needs SSA Form SSA-159?
01
Individuals who have received medical services and are seeking reimbursement from Social Security.
02
Health care providers who are billing for services rendered to individuals under specific Social Security benefit programs.
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What is SSA Form SSA-159?
SSA Form SSA-159 is a form used to request the Social Security Administration (SSA) to determine the fees charged by the representative for services rendered on behalf of a claimant.
Who is required to file SSA Form SSA-159?
SSA Form SSA-159 is required to be filed by representatives of claimants, such as attorneys or non-attorney advocates, who are seeking to have their fees approved by the SSA.
How to fill out SSA Form SSA-159?
To fill out SSA Form SSA-159, you need to provide information about the claimant, the services provided, and the amount of fees requested. You must also include signatures from both the representative and the claimant.
What is the purpose of SSA Form SSA-159?
The purpose of SSA Form SSA-159 is to facilitate the SSA's review and approval of the fees that representatives charge for their assistance in the claims process.
What information must be reported on SSA Form SSA-159?
The form requires details such as the claimant's name and Social Security number, the representative's name and contact information, a description of the services rendered, and the total amount of fees requested.
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