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.
Indicate:
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.