Representative Payee, Earnings Record, Direct Deposit & Overpayment Forms

Quickly access forms to establish or remove a representative payee, to contest the fact or collection of an overpayment, and to set up or change direct deposit.

Representative Payee Forms: The base application to be a representative payee for another person or to request direct payment to oneself is the SSA-11-BK. When applying for direct payment, an SSA-787 completed by your physician can be helpful. When applying to be payee for a child who is not in your physical custody, an SSA-789-U4 would help support your application.

Overpayment and Other Forms: If you disagree with the fact of an overpayment, file your request for reconsideration on form SSA-561. If you agree the overpayment occurred but feel you were not at fault in causing the overpayment and cannot afford to repay, you can file an SSA-632-BK requesting that the overpayment not be collected. Both of these forms can be found below as well as forms for requesting direct deposit and correction of your earnings record, if needed.

Please click on the link below to open your desired form in a separate browser window. You can then download the form from Benefits.com directly to your computer.

SSA-11-BK Request to Be Selected as Representative Payee

SSA-632-BK Request for Waiver of Collection of Overpayment

SSA-795 Statement of Claimant or Other Persons

SSA-787 Physician Statement of Capability

SSA-781 Certificate of Responsibility for Welfare and Care of Child

For use in applying to be payee for a child not in your physical custody)

SF1199A Request for Direct Deposit Set Up/Change

SSA-7008 Request for Correction of Earnings Record

SSA-3105 Important information about your appeal, waiver rights and repayment options