SSA-1588-OCR-SM (Current Version)

Beneficiary Recontact Report
INSTRUCTIONS FOR COMPLETING THE BENEFICIARY
RECONTACT REPORT
1. Use black ink or a No. 2 pencil to complete this report.
2. Keep your numbers a n d "X's" inside the boxes.

3. Try to make your numbers look like these.

If y o u a r e r e c e i v i n g mother'slfather's b e n e f i t s , a n s w e r as follows:
Question l a . Answer "No" unless you remarried since you began receiving Social
Security benefits based on your deceased spouse's Social Security number.
If you have remarried, answer "Yes" a n d remember to complete l b a n d lc. If the
person to whom you a r e currently married receives Social Security benefits,
complete I d a n d l e .
Question 2a. Answer "Yes" if you have a minor child under age 16 or a child disabled
since before age 22 in your care. Remember to sign and date t h e form a n d return it in
the envelope provided.
If you do not have a child in your care, answer 2a "No" and complete 2b. Sign and
date the form and return it in the envelope provided.
If y o u a r e 17 a n d r e c e i v e b e n e f i t s as a c h i l d , a n s w e r q u e s t i o n 1 as follows:
Question l a . If you answer "No", sign a n d date the form a n d return it in the
envelope provided. If you answer "Yes", answer l b , and return the form.

BE SURE TO RETURN THE FORM TO:
Social Security Administration
Wilkes-Barre Data Operations Center
P.O. Box 5888
Wilkes-Barre, PA 18767-5888

Continued on the
Reverse b

Privacy ActJPaperwork Reduction Act Notice
Sections 202(g) and 202(d) of the Social Security Act and regulations 20 CFR 404.703
and 20 CFR 404.705 authorize u s to ask you to complete this report because you continue
to be entitled to mother'slfather's or child's benefits a s long a s you a r e unmarried and,
for mother'slfather's benefits a s long a s you have a child entitled to benefits in your
care. We must ask you to complete this report when you receive these benefits and
giving u s the information is mandatory. If you do not give u s the information requested,
we must stop your benefits.
Sometimes the law requires u s to give out the facts on this report without your consent.
We may release this information to another person or government agency if Federal
law requires t h a t we do so or to do t h e research and t h e audits needed to administer or
improve our program.
We may also use the information you give u s when we match records by computer.
Matching programs compare our records with those of other Federal, State, or local
government agencies. Many agencies may use matching programs to find or prove that
a person qualifies for benefits paid by the Federal government. The law allows u s to do
this even if you do not agree to it.
These and ot,her reasons why information about t h e child may be used or given out are
explained in the Federal Register. If you want to learn more about this, contact any
Social Security office.
t s of 44 U.S.C. $3507, a s

If You Have Any Questions
If you have a n y questions, call u s a t 1-800-772-1213.We can answer most questions
over the phone. If you prefer to visit one of our offices, please check t h e local telephone
directory for t h e office nearest you. 01-call u s and we can give you the office address.
Please have this letter with you if you call 01. visit a n office. I t will help u s to answer
your questions.

Beneficiary Recontact Report

FORM APPROVED
OMB NO. 0960-0502

Social Security ~dministratio;, P.O. Box 5888, Wilkes-Barre, PA 18767z888
BENEFICIARY'S NAME AND ADDRESS

FORM DATE

SOCIAL SECURITY NUMBER BIC

BENEFICIARY

.. - DOEC

RQC

TYPE

PC

WHAT YOU NEED TO DO:
Please read the enclosed instructions before you complete this report. Then complete this report and send it to us in the enclosed
envelope within 30 DAYS. I F YOU DO NOT RETURN IT PROMPTLY, WE WILL STOP SENDING CHECKS TO YOU.

YES

1,

0

k

a. Are you married?
b. Enter the month and year you married.
)
Show the month and year in numbers. Example May 1990
05 90

MONTH

m a

*

c. Is your spouse receiving
Social Security benefits?

n

YEAR

YES

f

d. Enter the Social Security claim number in which
your spouse receives benefits?

0

0

i

SOCIAL SECURITY NUMBER

[In-m-rrrn

e. Print your spouse's name )
-

2.

YES

a. Do you have children who receive Social Security
benefits living with you?

0

Answer YES if the child:
lives with you, OR
is temporarily away, for example a t camp,
school, or visiting a relative, and you expect
the child to return, OR
does not live with you but you make the
important decisions about the child's
welfare.
b. Enter the date the child
stopped living with you.
Show the month, day, and year in numbers

SIGN HERE

35

=
=

=
=
-

e
I

=

MONTH

DATE

m m m

Day Tune Telephone Number(s)
(Include Area Codes )

(---)

Area Code

Date Signed

Form SSA-1588SM (4-2002)

0

-

=
-

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Thefollowing revised PRA Statement will be inserted into the form at its
next scheduled reprinting:
Paperwork Reductiod Act Statement - This information collection meets the
requirements of 44 U.S.C. 5 3507, as amended by section 2 of the Paperwork Reduction
Act of 1995. You do not need to answer these questions unless we display a valid Office
of Management and Budget control number. We estimate that it will take about 5
minutes to read the instructions, gather the facts, and answer the questions. You may send
comments on our time estimate above to: SSA, 6401 Security Blvd, Baltimore, MD
21 235-6401. Send&o comments relating to our time estimate to this address, not the
completed form.