Representative Payee Evaluation Report

SSA uses the Representative Payee Evaluation Report, Form SSA-624-F5, as a documentation tool for interviews with, and evaluations of, representative payees. SSA requires our field offices (FO) to conduct a face-to-face interview with the representative payee using Form SSA-624-F5 when: (1) SSA finds the payee’s responses on SSA-required annual accounting reports [Forms SSA-623, SSA 6230, and SSA-6234 (OMB No. 0960 0068)] unacceptable, and we cannot resolve them; (2) the payee fails to complete SSA’s initial and second request for an annual accounting report; or (3) assessing the representative payee’s continued suitability. In addition to the representative payee, we also interview the beneficiary or SSI recipient, and custodian (if other than the payee) to confirm information the payee provides, and to ensure the payee is meeting the beneficiary’s or SSI recipient’s current needs (face to-face interview not required). The respondents are individuals or organizations serving as representative payees for individuals receiving Title II benefits or Title XVI payments who fail to comply with SSA’s statutory annual reporting requirement, SSA beneficiaries or recipients, and third-party custodians.

The latest form for Representative Payee Evaluation Report expires 2026-07-31 and is listed under ICR 202204-0960-005.

Representative Payee Evaluation Report--Individuals/Households

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.