TN 29 (03-09)

GN 00605.360 Preparation of the Representative Payee Report Form

When requesting a final accounting, the technician must enter certain identifying information on the form before mailing it to the payee. Fill in the following fields on the form as instructed:

  1. 1. 

    Payee’s name and address

    Enter the Payee legend as it appeared on the MBR or SSR prior to the payee’s termination.

  2. 2. 

    Report period

    Enter the period for which the payee must account.

    • The “FROM” date is the month after the date of selection of the former payee.

    • The “TO” date is the month the change of payee or payee termination action is taken.

      A technician can often derive the FROM and TO dates by reviewing the SSR or MBR. If the dates cannot be determined by reviewing the payment records, the technician should:

    • Go to SSA Main Menu, select 9 (Master File Query) and hit Enter;

    • Select 17 (QRSL Inquiry Response) on the Master File Query menu, input the SSN and hit Enter;

    • Input “I” (HIST PAYEE/ADDRESS) under the “Selection” column for the beneficiary on the “QUERY RESPONSE SELECTION LIST” screen and hit Enter.

      The “FROM DATE” for the report period will be the month after the date shown in the “PAYEE 1 DATE” on the HPNA (Historical Payee Name Address) screen.

  3. 3. 

    Social Security Number

    Enter the Social Security Number (SSN) under which the beneficiary receives benefits. For concurrent cases, enter the Title XVI SSN.

  4. 4. 


    Enter the beneficiary’s full name.

  5. 5. 


    Enter for the beneficiary:

    • Beneficiary Identification Code (BIC) for Title II cases

    • Individual Recipient Identification Code (ID) for Title XVI cases, and

    • ID and BIC for concurrent cases

  6. 6. 

    Processing Center (PC)

    For Title II cases, enter the number of the PC servicing the claim.

  7. 7. 

    District office (DO) code

    Enter the code of the servicing field office.

  8. 8. 

    Beneficiary Social Security Number (BSSN)

    Enter the beneficiary’s SSN if it differs from the claim number under which the beneficiary receives benefits.

  9. 9. 


    Enter the Total Accountable Amount (TAA) in Item 3 of the report form. This amount represents the total amount paid to the beneficiary during the time shown in the “Report Period” section and any conserved funds that were reported previously by the former payee. When computing the TAA remember to subtract any checks that the former payee returned to SSA.

    After entering the required data, mail the final accounting report form to the former representative payee with instructions to complete and return it to the FO.

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GN 00605.360 - Preparation of the Representative Payee Report Form - 06/05/2013
Batch run: 04/25/2016