Retention Date: 04/30/2027
A. Background
To be eligible for SSI, applicants, recipients, and deemors must authorize SSA to contact financial institutions. To provide an additional service channel for collecting financial permission for SSI, we are introducing the SSA-4641 OP1, which is an abbreviated version of the SSA-4641. Effective with the 10/31/2026 release, it is available in Upload Documents.
B. Policy
When you complete a claim, including a pre-effectuation review contact (PERC), redetermination, or the Statement of Income and Resources form that is included in the SSI claim path when certain deeming situations apply, the signature obtained for these forms will also serve as a signature for the financial permission when all the following conditions are met:
· Permission is collected from an individual who has authority to provide it;
· Permission is requested as a question in the SSI application, redetermination, or Statement of Income and Resources; and
· The appropriate attestation procedures are followed.
We collect financial permission using the SSA-4641 OP1 when it cannot be collected in the SSI Claims system during claim and redetermination events. The new form replaces the financial permission request letters in the Document Processing System (DPS). Those notices have been converted into cover letters for the SSA-4641 OP1.
NOTE: Please continue to use the standard form SSA-4641 for requesting financial information from non-participating financial institutions. For more information see SI 01140.206E.1.b and SI 01140.206F.7.
C. Procedure
SSA-4641 OP1 is an abbreviated version of the standard SSA-4641 and is used only to collect financial permission for SSI program purposes. Do not use the SSA-4641 OP1 for overpayment waivers when SSI eligibility is not involved. It does not contain the records request portion of the SSA-4641, which SSA and financial institutions use during bank account verifications.
The SSA-4641 OP1 is available through:
· Upload Documents;
· SSA.gov website; and
· Inform.
To request financial permission on the SSA-4641 OP1, use Upload Documents when appropriate, since this method allows for electronic signature and submission.
If you are mailing the SSA-4641 OP1, you must include the applicable DPS cover notice:
· For claimants or recipients, use the letter entitled Financial Permission Request Claimant (T16).
· For deemors, use the letter entitled Financial Permission Request Deemor (T16).
NOTE: Both cover notices are in the General section of the DPS. Because they contain different language, verify that the appropriate notice is selected.
· Print the appropriate financial permission request letter from DPS. Ensure the SSA-4641 OP1 is included as an enclosure. Mail the letter directly to the individual to complete and sign.
When requesting financial permission using the SSA-4641 OP1:
· Control for receipt of the financial permission form on the Development Worksheet page.
· Once received, record the response on the Financial Institutions Permission page and resolve any resulting permission issues on the Development Worksheet.
· If the individual gives permission, store the form electronically using Evidence Portal. For mailed forms, return the original copy of the financial permission request letter to the individual.
· If the form has not been returned within 15 days, follow up by phone or mail. If the individual refuses permission or fails to return the form within the 30-day closeout period (and, in the case of deemors, good cause does not exist), deny or suspend benefits as described in SI 00515.001F.
Please direct program-related and technical questions to your management. If further assistance is required, use vHelp as directed.
References:
SI 00515.001 Requirement for Permission to Contact Financial Institutions for Supplemental Security Income (SSI) Eligibility
SI 01140.206 Electronic Financial Institution Verification