TN 30 (12-10)
In some instances, it may be necessary to translate several brief but related items
related to the same issue.
If possible, translate all items related to the same issue on a single form SSA-533,
(Translation Request), OS 15010.165. Show the exact type of evidence submitted.
Number each receipt and show the corresponding number on the translation form.
The name of the individual and the date expenses were incurred;
An itemized account of the goods and/or services rendered and the cost of each;
The name, address, and occupation of the person who supplied the goods and/or services;
The total amount paid;
The date paid; and
The name of the payer.