SSA-623: Representative Payee Report (Adult Beneficiaries)

Social Security Administration
Representative Payee Report
Why You Received
This Form

We must regularly review how representative payees used
the benefits they received on behalf of the Social Security
and/or Supplemental Security Income (SSI) beneficiaries.
We do this to ensure the benefits are used properly. When
you were appointed representative payee, you were informed
of the duties and responsibilities of a representative payee,
including keeping records and reporting on the use of
benefits.

What You Need To Do

You must report to SSA on your use of benefits if you
received any Social Security and/or SSI payments during the
12 month period shown on the enclosed form. You must do
this if you wish to continue receiving benefits on behalf of
another person. You should use the records you have saved
to answer the questions on the enclosed form.
You may submit this form online via www.ssa.gov/bso.
Please follow the instructions for Internet Payee
Accounting Report. If you complete the form online, you
will be able to print a receipt and a copy of your report.
If you report online, you should have all your records
and the enclosed form handy to help you answer the
questions. You should not send in a paper form if you if
you complete the online version.
Any records you have saved such as bank statements,
cancelled checks, receipts for rent, etc., should be kept for
two years from the time you file your report with SSA. You
should not send in any of these records with your report
form. If we have any questions or require proof, we will
contact you.

General Instructions If
You Complete and
Return The Enclosed
Form

Please read these instructions before you complete the
enclosed report form or submit your report online. You
should either complete and return the report form, or submit
the online report, within 30 days.
To help us process your report, please follow these
instructions:
1. Use black ink.
The rest of the instructions from this point on are
unchanged