Where to File SSA-11-BK?
The form SSA 11-BK can be filed during the face-to-face interview at the SSA office. If the form is mailed, faxed or dropped, the interview must follow anyway.
How to Fill out SSA-11-BK?
The instructions for filling out the Social Security request to be selected as payee can be found below.
Form SSA-11-BK Instructions
- Heading. Enter your name and social security number and the name of the beneficiary and their social security number;
- Item 1. Check the box if you are filing a request for direct payment. This item applies to the beneficiary only;
- Item 2. Provide an explanation as to why the beneficiary requires a representative payee. If they are a minor child, check the box;
- Item 3. Provide a reason why you should be chosen as a representative payee for that person. It the provided space is not enough, use the Remarks section;
- Item 4. Check the applicable box, indicating a way you will know about the beneficiary's needs;
- Item 5. Specify, whether the beneficiary has a court-appointed legal guardian. If the answer is positive, provide the name, address, phone number and title of this person and the date they were appointed. Describe the circumstances of appointment;
- Item 6a. Check the applicable box indicating the beneficiary's place of residence;
- Item 6b. Check the item if the beneficiary lives with other people. Provide their names and the relationship to the beneficiary;
- Item 6c. This item applies if the beneficiary lives in an institution. Provide the name, mailing address and phone number of this institution;
- Item 6d. Check the applicable box indicating whether the beneficiary's living arrangements are to be changed in the next year. Provide an explanation in the Remarks section;
- Item 7. This item should be filled if the applicant desires to become a representative payee of a minor child and they are not the child's parent. Specify whether the child has a living natural or adoptive parent. If the answer is positive, provide their name, address, phone number and indicate whether the parent shows interest in the child. Provide an explanation;
- Item 8. Enter the names and addresses or phone numbers of people who show active interest in the beneficiary. Provide the relationship of the beneficiary to these people and give a brief description of how the interest is displayed;
- Item 9. Check the box indicating your relationship to the beneficiary. If you checked any box in (a) option, complete only items 10 and 11 and sign the form. If any other option is chosen, skip these items and go to item 12;
- Item 10. Indicate, whether the beneficiary owes you or the organization you represent any money. If they do, provide the information about the debt: its amount, the date it occurred and how it is going to be incurred;
- Item 11. Enter the name of the institution, agency or bank you represent and the Employer Identification Number (EIN) of the organization;
- Item 12. Provide your name, date of birth, social security number, names and social security numbers you used in the past, if any;
- Item 13. Provide information about how long you have known the beneficiary;
- Item 14. Provide the information about the person taking the beneficiary to work or any other outside activity, if they live with you. Enter the relationship of this person with the beneficiary;
- Item 15a. Check the box, indicating your main source of income;
- Item 15b. Enter the name and address of your employer if you are employed. Enter the duration of your employment;
- Item 16a. Check the box, indicating, whether you have ever been convicted of a felony. The positive answer must be followed by the information about the crime: when you were convicted, what was the sentence, were you imprisoned and if you were - when you were released, and if prohibition was ordered - when it will end;
- Item 16b. Indicate, whether you have ever been imprisoned for more than one year. If you were, provide information about the crime, the sentence, when were you released and when the prohibition will end, in case it was ordered;
- Item 17. Indicate whether you have any unsatisfied felony warrants. If you have, enter the date of the warrant and the place it was issued;
- Item 18. Enter the date you moved into your current house in MM/YY format;
- Sign and date the form. Provide your phone number. Enter your mailing address and residence address. If you are a representative of an organization, print your name and title.