Form SSA-1588-OCR-SM Beneficiary Recontact Report

1588
Beneficiary Recontact Report

FORM APPROVED
OMB NO.0960-0502

Social Security Administration, P.O. Box 5888, Wilkes-Barre, PA 18767-5888
FORM DATE

SOCIAL SECURITY NUMBER

BIC

BENEFICIARY

RQC

DOEC

PC

TYPE

If change of address, correct and check box.

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. IF YOU DO NOT
RETURN IT PROMPTLY, WE WILL STOP SENDING CHECKS TO YOU.
YES
NO
a. Are you married?

1.

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b. Enter the month and year you married.
Show the month and year in numbers.
Example: May 1990 > 05 1990

YES

NO

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

2.

YEAR

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c. Is your spouse receiving
Social Security benefits?

e. Print your spouse’s name

MONTH

SOCIAL SECURITY NUMBER

u

u
YES

a. Do you have children who receive Social Security
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benefits living with you?
Answer YES if the child:
• lives with you, OR
• is temporarily away, for example at 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

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MONTH

NO

DATE

YEAR

I declare under penalty of perjury that I have examined all the information on this form, and on
any accompanying statements or forms, and it is true and correct to the best of my knowledge.

SIGN HERE

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Form SSA-1588-SM (xx-xxxx)

Daytime Telephone Number (Include Area Code)

Date Signed

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 and X’s” inside the boxes.
3. Try to make your numbers look like these.

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01 2 3 4 56 7 8 9

If you are receiving mother’s/father’s benefits, answer as follows:
Question 1a. 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” and remember to complete 1b and 1c. If the
person to whom you are currently married receives Social Security benefits,
complete 1d and 1e.
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 the form
and 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.

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

Form SSA-1588-SM (xx-xxxx)

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Privacy Act Statement
Collection and Use of Personal Information
Sections 202(g) of the Social Security Act as amended, [42 U.S.C. 402(g)] and Title 20 CFR
404.703 and 20 CFR 404.705 authorizes us to ask you to complete this form because you
continue to be entitled to mother's/father's or child's benefits as long as you are unmarried and
for mother's/father's benefits as long as you have a child entitled to benefits in your care. The
information you provide on this form is voluntary. However, failure to provide all or part of the
requested information could prevent us from making an accurate and timely decision on your
claim.
We rarely use the information you provide on this form for any purpose other than for the
reasons explained above. However, we may use it for the administration and integrity of
Social Security programs. We may also disclose information to another person or to another
agency on accordance with approved routine uses, which include but are not limited to the
following:
1. To enable a third party or an agency to assist Social Security in establishing
rights to Social Security benefits and/or coverage;
2. To comply with Federal laws requiring the release of information for Social
Security records (e.g., to the Government Accountability Office, General Services
Administration, National Archives Records Administration, and the Department of
Veterans Affairs);
3. To make determinations for eligibility in similar health and income maintenance
programs at the Federal, State, and local level; and
4. To facilitate statistical research, audit or investigative activities necessary to assure
the integrity of Social Security programs.
We may also use the information you provide in computer matching programs.
Matching programs compare our records with records kept by other Federal, State or local
government agencies. Information from these matching agencies can be used to establish or
verify a person's eligibility for Federally-funded or administered benefit programs and for
repayment of payments or delinquent debts under these programs.
A complete list of routine uses for this information is available in our Systems of Records
Notice entitled Claims Folder System 60-0089. The notice, additional information regarding
this form, and information regarding our system and programs, are available on-line at
www.socialsecurity.gov or at any local Social Security office.

Form SSA-1588-SM (xx-xxxx)