Financial Disclosure for Civil Monetary Penalty (CMP) Debt

When SSA imposes a civil monetary penalty (CMP) on individuals for various fraudulent conduct related to SSA-administrated programs, those individuals may request to pay the CMP through benefit withholding, or an installment agreement. To negotiate a monthly payment amount, fair to both the individual and the agency, SSA needs financial information from the individual. The agency uses Form SSA-640 to obtain the information necessary to determine a monthly installment repayment rate for individuals owing a CMP. The respondents are recipients of Social Security benefits, and non-entitled individuals who must repay a CMP to the agency and choose to do so using an installment plan. We are submitting a non-substative change request to remove the signature requirement from Form SSA-640.

The latest form for Financial Disclosure for Civil Monetary Penalty (CMP) Debt expires 2026-07-31 and is listed under ICR 202504-0960-005.