GN PHI00504.100 C Payment of Benefits Pending Investigation Commonwealth of Pennsylvania's DPW Facilities

See GN 00504.100

The mental facilities of Pennsylvania's Department of Public Welfare (DPW) will use a standard report form to report the transfers, discharges, and deaths of Social Security recipients for whom the guardian officers serve as representative payee. The reports will be faxed to the field office serving the mental facility at which the recipient was a resident. They are first party reports because the reporter is the payee. Therefore, in the instance of a report of discharge or transfer, confirmation with the recipient is not required. A facsimile of the report is included on the next page.

The field office will take the following actions:

  • If Item 1 is completed, the payee is advising that the recipient has been transferred to another DPW facility. A payee application from the guardian officer of the new facility should be secured, and advance notice is required since the payee is changing. General instructions for processing RPS applications can be found in MSOM chapters 238 through 244.

  • If Item 2 is completed, the recipient has been discharged from the DPW facility and is in the care of a new custodian. You should contact the recipient and the new custodian, whose name, address, and phone number are being provided, to determine who should be appointed the new payee. If the DPW is also reporting that it has conserved funds of the recipient, you should contact the reporter, whose name and phone number are at the bottom of the form, and advise them either to return the money to SSA or to forward the money to the new payee. See GN 00603.055 through GN 00603.130 for additional procedure for transfers of conserved funds. If the DPW is reporting an outstanding care and maintenance balance, you should advise the new payee of this fact. See GN 00602.030 for procedure concerning claims of creditors.

  • If Item 3 is completed, process the report of death according to the instructions in GN 02602.050.

TO: Social Security Field Office,

_____________________________, Pennsylvania

FROM: ______________________(facility name), ________________________,



NAME: _____________________________________________________

SOCIAL SECURITY NUMBER: _________________________________

1. TRANSFER DATE: ________________________________________

Transferred to: _______________________________________________

2. DISCHARGE DATE: _______________________________________

The new custodian is: _____________________________________

Address: ___________________________________________________

Phone Number: ______________________________________________

Amount of conserved SSA funds at date of discharge: ___________

Outstanding care and maintenance charges: ___________________

3. DATE OF DEATH: ____________________________________


Signed: ________________________________________ (facility representative)

Phone #: _________________________Date: ____________________________

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GN PHI00504.100 - C Payment of Benefits Pending Investigation Commonwealth of Pennsylvania's DPW Facilities - 10/05/2022
Batch run: 04/21/2023