Financial Disclosure for Civil Monetary Penalty (CMP) Debt

OMB 0960-0776

OMB 0960-0776

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 nonentitled individuals who must repay a CMP to the agency and choose to do so using an installment plan.

The latest form for Financial Disclosure for Civil Monetary Penalty (CMP) Debt expires 2021-10-31 and can be found here.


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