CM-623S Representative Payee Report (Short Form)

Representative Payee Report, Representative Payee Report (Short Form), and Physician's/Medical Officer's Statement

cm-623s

Representative Payee Report, Representative Payee Report (Short Form), and Physician's/Medical Officer's Statement

OMB: 1240-0020

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1240-0020 can be found here:

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File Type	application/pdf
File Title	DOL-ESA Forms
Subject	cm-623s
Author	Richard Maley
File Modified	2017-10-25
File Created	2014-07-18