Current SSA-6230

Social Security Administration
Representative Payee Report
Why You
Received
This Form

We must regularly review how representative payees, including parents,
stepparents, and grandparents with custody of minor children, 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.
The name(s) of the child(ren) we are asking about are shown in item 3 on the form.
If you receive benefits for children not named in item 3, we will send you another
form. Use this form only for the child(ren) named in item 3.
You may submit this form online via www.socialsecurity.gov/payee. 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 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.
2.
3.
4.

Use black ink.
Keep your numbers and “X’s” inside the boxes.
Do not use dollar signs.
Show money amounts in dollars only. Do not show cents.
For example, show $1,540.70 like this:
DOLLAR AMOUNT

,.

5. Use the REMARKS section on the back of the form to provide additional
information as requested.
6. Review the payee mailing address and correct if necessary. If you change the
payee mailing address to a P.O. Box, show the payee’s actual physical address in
REMARKS.
7. Be sure you, the representative payee, sign the form.

FORM SSA-6230-OCR-SM (10-2008)

1

Continued on the Reverse

Some
Definitions
To Help You

Benefits – The Social Security and/or SSI money that you receive.
Payee – You. The person who receives Social Security and/or SSI benefits for
someone else.
Beneficiary – The person for whom you receive Social Security and/or SSI benefits.
Report Period – The 12-month period shown on the report for which you must
account for the benefits you received.
Total Accountable Amount – The amount of benefits paid to you during the
report period plus any amount you reported as saved on last year’s report.

HOW TO FILL OUT THE FORM
QUESTION 1 –
Payee Felony
Convictions

Place an “X” in the “YES” box if during the report period, you (the
payee) were convicted of a crime considered to be a felony and
explain the type of crime under REMARKS. Otherwise, place an “X”
in the “NO” box.

QUESTION 2 –
Does The
Child(ren)
Live With You?

Place an “X” in the “NO” box if any of the children named in item 3
did not live with you in all of the months in the report period or any
of the children are not living with you now. Explain the change and
provide the child(ren)’s current address under REMARKS.
Note: Do not consider vacations, weekend or other short
visits when you answer this question.

QUESTION 3 –
Accounting
For Benefits

The total accountable amount includes the benefits you received
during the report period plus any benefits you reported as saved on
last year’s report.

A. Who Decided
How Benefits
Were Used?

Place an “X” in the “YES” box if you (the payee) decided how to use
the money. Place an “X” in the “NO” box if you turned over the full
amount of benefits for any of the children to another person who
decided how to use the money. Explain under REMARKS to whom the
money was given and why.

B. Amount
Spent

Show the total amount of benefits spent to care for all the children
named in item 3. This amount includes food, housing, clothing,
medical and dental expenses, recreation and education.

C. Unused
Benefits

Show the amount of benefits you saved for the child(ren) at the end
of the report period, including any interest earned. Show zeroes if you
did not save any of the benefits.

FORM SSA-6230-OCR-SM (10-2008)

2

QUESTION 4 –
Savings
Information

Answer this question if you showed an amount in 3.C.

A. Type Of
Account

Place an “X” in the box which shows how you are saving the
benefits. Place an “X” in the “Other” box if your method of saving
the benefits is not listed.

B. Account
Title

Place an “X” in the box which most accurately describes the
account title you have on the child(ren)’s savings. Place an “X” in
the “Other” box if the account title is different or if you have not
placed the savings in any type of account. Note: A savings or
checking account title should always show that the money
belongs to the child(ren), but the child(ren) should not
have direct access to the funds.

QUESTION 5 –
Other Savings/
Account Titles

Answer this question only if you checked “OTHER” in 4.A. or 4.B.

Type Of
Account

Indicate whether the saved benefits are in cash, Treasury Bills, or
some other investment such as mutual funds. For mutual funds,
be sure to show the name of the fund in your response (e.g., “XYZ
Growth” mutual fund).

Title Of
Account

Show the title of the account if the savings are in an account or
other investment. Show “none” if the savings are not in an account
or investment.

6. Payee’s
Signature

Sign your name in this block. If you sign by mark (“X”), please
have two witnesses sign their names and show the date.

Your Responsibilities As payee, you must use the Social Security and SSI benefits you
receive for the care and well being of the child(ren).
As Representative
Payee
In addition to reporting on the use of benefits, you must report any
changes which may affect the child’s eligibility for benefits, or the
payment amount.
You should report the changes as soon as possible by calling SSA
at 1-800-772-1213, or by calling or writing your local SSA office.

Continued on the Next Page
FORM SSA-6230-OCR-SM (10-2008)

3

Your Responsibilities For example, you must tell us if the child:
As Representative
• moves,
• marries,
Payee (continued)

• goes to work,
• is adopted,
• is imprisoned, or
• you are no longer responsible for the child.
If you are payee for a child receiving SSI benefits, we may ask you
for proof that the child is receiving medical treatment for his/her
disabling condition. We may ask for this information at the time
we review the child’s case. If we do ask for this information, you
must give it to us.
If you are no longer payee for the beneficiary, you must return any
funds you have saved to SSA.

The Privacy Act
And Paperwork
Reduction Act
Statements

We are required by sections 205(j) and 1631(a) of the Social
Security Act to ask you to complete this report. The information
you provide enables SSA to account for the child(ren)’s payments,
and ensures that his/her needs are being met. If you do not
complete and return this report, we may not be able to continue
sending the child(ren)’s payments to you.
The law sometimes requires us to give out the facts on this
form without your consent. The information must be released
to another person or government agency if Federal law requires
the information for research and audits in order to administer or
improve our representative payee program.
We may also use the information you give us 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 us to do this even if you do not agree to it. Explanations
about these and other reasons why information you provide us
may be used or given out are available in Social Security offices.
If you want to learn more about this, contact any Social Security
office.
This information collection meets the requirements of 44 U.S.C.
§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 15 minutes to read
the instructions, gather the necessary facts, and answer the
questions. You may send comments on our time estimate above
to: SSA, 1338 Annex Building, Baltimore, MD 21235. Send only
comments relating to our time estimate to this address, not
the completed form.

If You Have
Any Questions

If you have any questions, please call us at 1-800-772-1213. We
can answer most questions over the phone. If you prefer to visit
one of our offices, please use the 800 number and we will give you
the address and telephone number of the office nearest you. Please
take this report with you if you visit an office. You may also visit
our website at www.socialsecurity.gov.

FORM SSA-6230-OCR-SM (10-2008)

4