SSA-11-BK 2009 free printable template

Use remarks if you need more space. Form SSA-11-BK 08-2009 Destroy Prior Editions EF 08-2009 Page 1 NO a Where does the claimant live Alone In my home Go to b. SOCIAL SECURITY ADMINISTRATION Form Approved OMB No* 0960-0014 TOE 250 FOR SSA USE ONLY Name or Bene. Sym* Program Date of Birth Type Gdn* Cus. Inst* Nam* REQUEST TO BE SELECTED AS PAYEE DISTRICT OFFICE CODE STATE AND COUNTY CODE PRINT IN INK The name of the NUMBER HOLDER The name of the PERSON S if different from above for whom you...

How to fill out SSA-11-BK

How to fill out SSA-11-BK

1. Obtain the SSA-11-BK form from the Social Security Administration website or local office.
2. Fill out personal information in Section 1, including your name, Social Security number, and contact information.
3. In Section 2, indicate your relationship to the person for whom you are applying for benefits.
4. In Section 3, specify the type of benefits you are requesting.
5. Provide information about your and the applicant's work history in Section 4.
6. Complete Section 5 by answering questions about medical conditions if applicable.
7. Review the form for accuracy and completeness.
8. Sign and date the form in Section 6.
9. Submit the completed form to the Social Security Administration either by mail or in person.

Who needs SSA-11-BK?

1. Individuals who are applying for Social Security benefits on behalf of another person.
2. Family members or representatives assisting someone who is unable to apply on their own due to disability or other circumstances.

• Who needs a Form SSA-11-BK?
• What is Form SSA-11-BK for?
• • When is Form SSA-11-BK due?
  • How do I fill out Form SSA-11-BK 2009?
  • Where do I send Form SSA-11-BK?

Who needs a Form SSA-11-BK?

A person who would receive the Social Security Administration payments (benefits) on behalf of another person due to certain circumstances must file SSA-11-BK Form, Request to Be Selected as Payee, in order to become a representative payee.

What is Form SSA-11-BK for?

A person’s request on this form for SSI payments on behalf of the individual named in this form is to be processed and considered by the Social Security Administration. After the consideration, this application may be approved, and a claimant will become an authorized payee.

Based on information provided, the SSA evaluates payee applicants’ suitability to be named representative payee. Also, information provided on this form is used for computer matching programs comparing the SSA records with those of other Federal, state or local government agencies. Information provided by the matching programs is used to verify person’s eligibility for federally funded or administered benefit programs and repayment of payments.

You can check the complete list for use of this information in SSA System of Records Notice 60-0222.  

All the payments under this document must be used for the claimant’s needs or to be kept for needs that may arise in the future.

When is Form SSA-11-BK due?

This form must be filed when the need arises. There is no specific deadline for filing the form with the SSA office.

The process of consideration will take some time which is unspecified and depends on the individual case.

How do I fill out Form SSA-11-BK 2009?

The following information must be provided in order to complete the form:

• The name of the Number Holder;

• Explanation of why the claimant is not able to handle their benefits;

• Explanation of why the filer would be the best representative payee;

• Information on relationships with the claimant and their family;

• Information about individual applying to be representative payee;

 

The last page of the form, A Reminder to Payee Applicants and Receipt for Your Request, is meant to be completed by the SSA clerk.

Where do I send Form SSA-11-BK?

Once completed and signed, this form should be delivered to the nearest local Social Security office.

 

 

Instructions and Help about SSA-11-BK

This is the work history report provided to claimants who have applied for Social Security disability benefits this form does come directly from the Social Security office it is not sent to you from your attorney it is sent to you from the Social Security office in order for them to gather all the information they need in order to make a decision on whether you qualify for disability benefits and if you will be awarded obviously the more work you have the more work credits you have which will affect the award amount we often have clients that ask us if they have to fill this out or how much of it they have to fill out do they really have to go back 15 years and the answer to those questions or yes to all of them you do need to fill this out your attorney cannot do this for you because you know your history the best however at least here at the Kali law firm where he'll be happy to help you walk you through the form and if you just physically cannot write or tie then of course we would help you with it if you don't have someone at home that can do it for you the first page section one just asks for your name social security number and daytime telephone number where you can be reached any time you need to put all this information in because this will associate it to your disability application section two is information about your work so the first portion it does asks to list all the jobs that you've had in the last 15 years you need to list everything that you've had what your job was what type of business it and the days that you work as close to as accurate as possible obviously 15 years ago it's hard to remember exact dates and that's fine don't worry about it just keep it as you know accurate as possible once you've listed just all your jobs and the next several pages each pages for each job and is asking for very specific information it's asking for your rate of pay whether it's hourly or salary how much you worked how many days per week that you worked and then a description of the job itself what did you do all day they're going to get a sense of just your type what type of work that you're qualified to do you were healthy and then ultimately based on this and then Medical has history and other things they'll be able to determine if you're able to continue doing this sort of job this is why you've hired an attorney we do the argument for you defense for you, but we do need you to fill out this information after you've given a description of the job you will just answer the remaining questions give them an idea of how often or how what the frequency of how much you did something like walking or standing were you on your feel a day did you have to crawl or crouched let's say you're someone that has a shoulder injury, and you can no longer lift things, but that's what all your work history is that's good supporting your case you want to make sure you give them accurate information of how much you lifted during your jobs again this section...

What is ssa 11 form?

Form SSA 11-BK, Request to Be Selected as Payee, is a form completed and returned to the Social Security Administration. The purpose of this form is to another person be named as payee other than the payee. This form is used when the original payee is unable to manage their own finances.

People Also Ask about

Can you submit SSA forms online?

Applicants filing over the internet also benefit from a streamlined process that allows for the online submission of all parts of their disability application. I am applying for disability benefits.

How do I get an SSA 11 form?

All forms are FREE. Not all forms are listed. If you can't find the form you need, or you need help completing a form, please call us at 1-800-772-1213 (TTY 1-800-325-0778) or contact your local Social Security office and we will help you.

What's an SSA 11?

The SSA-11-BK is the paper form a potential payee completes to apply to be payee. Use the paper form only, when it is not possible to use eRPS. For example, we must take paper applications for applicants who do not have a Social Security Number (SSN).

Can I fill out the representative payee report online?

You must be 18 or older to complete the Representative Payee Accounting Report online. If you are under 18 and a representative payee, you must complete the paper Representative Payee Report form you received in the mail and return it to the address shown on the form.

Can I print out Social Security forms?

Get a copy of your Social Security 1099 (SSA-1099) tax form online. Need a replacement copy of your SSA-1099 or SSA-1042S, also known as a Benefit Statement? You can instantly download a printable copy of the tax form by logging in to or creating a free my Social Security account.

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What is SSA-11-BK?

SSA-11-BK is a form used by the Social Security Administration (SSA) to request a child to receive benefits on the earnings record of a parent.

Who is required to file SSA-11-BK?

The form must be filed by the parent, guardian, or representative payee of a child who is applying for benefits.

How to fill out SSA-11-BK?

To fill out SSA-11-BK, you need to provide personal information about the child and the parent, including names, Social Security numbers, and details about the relationship.

What is the purpose of SSA-11-BK?

The purpose of SSA-11-BK is to facilitate the application process for children seeking benefits under a parent's Social Security record.

What information must be reported on SSA-11-BK?

The information required includes the child's information (such as name, Social Security number, and date of birth), the parent's information, and details about the claim for benefits.