TN 13 (07-19)

GN 02230.070 Exhibit - Form SSA-640 Financial Disclosure for a Civil Monetary Penalty Debt

Individuals with a Civil Monetary Penalty (CMP) debt who are requesting a change in their current payment arrangements should complete the form SSA-640 (Financial Disclosure for Civil Monetary Penalty (CMP) Debt).

Print the form for the debtor. Once the CMP debtor has completed the entire form, he or she should either mail or return it to the local Social Security office. Instructions for completing the form are located on page 8.

For more information, see Civil Monetary Penalty (CMP) – Overview GN 02230.050

To view this form, go to Form SSA-640.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0202230070
GN 02230.070 - Exhibit - Form SSA-640 Financial Disclosure for a Civil Monetary Penalty Debt - 05/24/2010
Batch run: 07/08/2019
Rev:05/24/2010