TN 13 (07-19)
GN 02230.075 Exhibit - Form SSA-640SP Financial Disclosure for a Civil Monetary Penalty Debt (Spanish
Version)
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 SSA-640SP.