Statement of Care and Responsibility for Beneficiary

OMB 0960-0109

OMB 0960-0109

SSA uses the information from Form SSA-788 to verify payee applicants' statements of concern and to identify other potential payees. SSA is concerned with selecting the most qualified representative payee who will use Social Security benefits in the beneficiary's best interest. SSA considers factors such as the payee applicant's capacity to perform payee duties, awareness of the beneficiary's situation and needs, demonstration of past and current concern for the beneficiary's well-being, etc. If the payee applicant does not have custody of the beneficiary, SSA will obtain information from the custodian for evaluation against information provided by the applicant. Respondents are individuals who have custody of the beneficiary in cases where someone else has filed to be the beneficiary's representative payee. Form SSA-788 is an agency generated form, which SSA completes the top portion of Form SSA-788, sends to the custodians of the beneficiaries, and they complete the rest of the form and gives back to us.

The latest form for Statement of Care and Responsibility for Beneficiary expires 2021-10-31 and can be found here.

All Historical Document Collections
Revision of a currently approved collection 2021-09-03
Approved without change
Revision of a currently approved collection 2018-07-30
Approved without change
Revision of a currently approved collection 2015-07-08
Approved without change
Revision of a currently approved collection 2012-09-27
Approved without change
Revision of a currently approved collection 2009-06-12
Approved with change
Extension without change of a currently approved collection 2006-06-14
Approved without change
Extension without change of a currently approved collection 2003-08-22
Approved without change
Extension without change of a currently approved collection 2000-07-03
Approved without change
Extension without change of a currently approved collection 1997-06-23
Approved without change
Revision of a currently approved collection 1994-05-06
Approved with change
No material or nonsubstantive change to a currently approved collection 1994-04-07
Approved without change
Revision of a currently approved collection 1992-07-24
Approved without change
Revision of a currently approved collection 1990-06-07
Approved without change
Extension without change of a currently approved collection 1987-07-16
Approved without change
Extension without change of a currently approved collection 1984-08-17
Approved without change
Revision of a currently approved collection 1981-09-24
Approved with change
No material or nonsubstantive change to a currently approved collection 1979-03-29
Approved without change
Revision of a currently approved collection 1977-01-13
Approved without change
Extension without change of a currently approved collection 1975-06-05

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