Before you may collect a fee for representative payee services, you must complete
and submit a form SSA-445, Application to Collect a Fee for Payee Services, requesting
authorization from the local Social Security office, and SSA must approve your application.
Your application must include all the information and documents listed below and be
signed by the Director of your organization or by another individual who can legally
act for the organization.
Information You Need To Give Us
The following information about your organization is required as part of the fee for
service application process:
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Employer Identification Number
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The organization’s mission statement
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Service area (the neighborhoods, cities, counties served)
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Statement showing whether the organization currently charges any of the beneficiaries
for its services.
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A list of the names, Social Security numbers, and residence addresses of beneficiaries
for whom the organization is currently providing representative payee services.
Documents You Need to Give Us If You Are Not a State
or Local Government Agency
Enclose the following documents with the request:
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A copy of the letter from the Internal Revenue Service granting tax-exempt status
under section 501(C) of the Internal Revenue Code.
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A copy of the organization's current bonding agreement with an insurance company (The
type of bond requested is the one that guarantees payment to the organization or the
Social Security Administration for unforeseen financial loss through the actions of
an employee.)
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A copy of the organization's current State license, certificate or notice that allows
it to provide service within the State.