Ssa-787 (05-2010)

Form SSA-787 (05-10).pdf

Application to Act as Representative Payee

SSA-787 (05-2010)

OMB: 3220-0052

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 3220-0052 can be found here:

2023-03-28 - Revision of a currently approved collection

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