Representative Payee Report, Representative Payee Report (Short Form), and Physician's/Medical Officer's Statement

Requesting address change for CM-787. Representative Payee Report (CM-623) and Representative Payee Report Short Form (CM-623S) are used to ensure that benefits paid to a representative payee are being used for the beneficiary's well-being. Physician's/Medical Officer's Statement (CM-787) is used to determine the beneficiary's capability to manage monthly Black Lung benefits.

The latest form for Representative Payee Report, Representative Payee Report (Short Form), and Physician's/Medical Officer's Statement expires 2021-04-30 and can be found here.