TN 8 (11-06)

GN 00506.010 Providing Information to Prospective Organizations and FFS Application Requirements

A. Policy - General

SSA should assist prospective applicants with the fee for service (FFS) application process and explain the program requirements.

Inquiries from a prospective FFS applicant must be forwarded to the servicing FO. The payee should be advised that a fee cannot be collected unless SSA authorizes them to do so.

B. Policy - Application Requirements

Before an organization may collect a fee for representative payee services, a form SSA-445, Application to Collect a Fee for Payee Services, must be completed and submitted to the local Social Security office, and SSA must approve authorization.

The following items are required from the organizational payee as part of the FFS application process:

1. Organization is a State or Local Government Agency

  • The SSA-445, Application to Collect a Fee for Payee Services

  • The organization’s mission statement,

  • The organization’s service area. (Zip codes, towns, or counties served),

  • A list of the beneficiaries the organization already serves, including name, address and SSN,

  • A statement as to whether or not the organization currently charges any of the beneficiaries for its services, or collects any fees/money from any other sources for providing payee services, and

  • The name and signature of the organization’s director or its designee who can legally act on behalf of the organization.

2. Organization is Not a State or Local Government Agency

In addition to the requirements stated in GN 00506.010B.1., if the organization is not a state or local government agency, the payee is also required to provide:

  • A copy of bonding and/or insurance agreement,

  • A copy of their state license (provided that licensing is available in the State), and

  • Proof of tax-exempt status in accordance with Sec. 501(c) of the Internal Revenue Code.

C. Procedure

Follow these procedures when responding to inquiries about fee for services:

  • Explain that organizations must meet certain requirements to qualify and that fees cannot be collected until written authorization is obtained from SSA.

  • Obtain the name and daytime telephone number of the inquirer and the name and address of the organization involved.

  • Inform the inquirer that information regarding collecting fees for representative payee services will be mailed.

  • Explain that records must be kept and are subject to oversight.

  • Prepare a notice using the language supplied in NL 00703.940. Include the appropriate FO contact name, FO address, and telephone number and fax number on FO letterhead.

  • Include the necessary exhibits supplied in NL 00703.941 and NL 00703.942 as attachments.

  • Include a form SSA-445, Application to Collect a Fee for Payee Services, as an attachment.

D. Exhibit

The following is an exhibit of form SSA-445, Application to Collect a Fee for Payee Services.

G-SSA-445-1

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G-SSA-445-2

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1. Description of Entry or Expected Answer

Use the following chart to determine what information is expected in answer to specific questions of the SSA-445 and how to evaluate those answers.

QUESTION

EXPLANATION

1

The organization’s full name (abbreviations acceptable).

2

The organization’s Employer Identification Number.

3

See GN 00506.100B. (Determines whether the organization is State/Local government agency or Community based, non-profit social service agency. Community based non-profit orgs. require bonding and licensing).

4

Address of the organization. If the org. uses a different for mail, then list both.

5

City, State, Zip Code & Telephone number of organization.

6

All non-governmental agencies must complete this section. This will supply information about the license the organization holds and the State in which issued. Licensing information should be current. (If information appears questionable refer to GN 00506.110B.4.).

7

All non-governmental agencies must complete this section. This

will supply information about the bond/insurance company, its

name, address and telephone number; the bond/policy type (e.g.,

Surety Bond, Commercial Coverage or Fidelity Bond); expiration

date (future dates only); serial/policy number and; the full amount

of the bond coverage. (If information appears questionable refer to GN 00506.110B.4.).

8

This may help in assessing the applicant’s ability to handle additional clients, if ever needed.

9

This may help in determining the suitability of the payee. A “Yes” response must be fully investigated, as they are not yet authorized to collect a fee.

2. Description of Entry or Expected Answer

Use the following chart to determine what information is expected in answer to specific questions of the SSA-445 and how to evaluate those answers.

10

This may provide the client-payee ratio and whether there is sufficient staff to handle our beneficiaries.

11

This may help in assessing the applicant’s ability to handle additional clients, if ever needed.

12

Helps to determine if the payee is a Creditor.

See GN 00506.100B.3.b.

Signature

Must be signed by the principal officer or its designee (an

individual who is authorized to enter into agreements on behalf of

the organization).

E. References

NL 00703.940 - Cover Letter to Organizations Inquiring About Payment for Representative Payee Services

NL 00703.941 - Fees for Representative Payee Services

NL 00703.942 – Explanation of Documents Needed to Collect a Fee for Representative Payee Services

NL 00703.943 - Notice Authorizing Organizations to Collect a Fee

NL 00703.945 - Explanation of Fees for Representative Payee Services


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0200506010
GN 00506.010 - Providing Information to Prospective Organizations and FFS Application Requirements - 02/17/2012
Batch run: 02/17/2012
Rev:02/17/2012