OMB control number
Medical Source Opinion of Patient’s Capability to Manage Benefits
OMB 0960-0024 · SSA.
OMB 0960-0024
SSA collects medical evidence on Form SSA-787 to: (1) determine beneficiaries’ capability or inability to handle their own benefits; and (2) assist in determining the beneficiaries’ need for a representative payee. The respondents are the beneficiary’s physicians or medical officers of the institution in which the beneficiary resides.
The latest form for Medical Source Opinion of Patient’s Capability to Manage Benefits expires 2027-06-30 and is listed under ICR 202111-0960-006.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form SSA-787 Medical Source Opinion of Patient’s Capability to Manage Benefits | Form |
 Addendum 0024.docx | Supplementary Document |
| Supporting Statement - 0024 (Final).docx | Supporting Statement A |
 Medical Source Opinion of Patient's Capability to Manage Benefits |
Form |
| Medical Source Opinion of Patient's Capability to Manage Benefits |
Form |
| Medical Source Opinion of Patient's Capability to Manage Benefits |
Other-Revised PA Statement |