SSA - POMS: GN 00502.115 - The SSA-11-BK, Request to be Selected As Payee

A. Introduction

This section provides guidance for using the SSA-11-BK to process a potential representative payee's (payee) application, when it is not possible to use the electronic Representative Payee System (eRPS).

B. Policy

The SSA-11-BK is the paper form a potential payee completes to apply to be payee. Use the paper form only, when it is not possible to use eRPS. For example, we must take paper applications for applicants who do not have a Social Security Number (SSN) and cannot be assigned one. If you appoint a payee who does not have an SSN, you must update the Master Beneficiary Record (MBR), Supplemental Security Record (SSR), or both with your payee selection via manual action, see GN 00502.190.

To the extent practicable, complete the SSA-11-BK in a face-to-face interview and retain a copy in eView using the Evidence Portal (EP) or the eView application, or in the Non-Disability Repository for Evidentiary Documents (NDRED) using the EP.

For instructions about telephone or video service delivery (VSD) interviews for undue hardship or subsequent face-to-face interviews, see GN 00502.113B.

For procedures on retaining the SSA-11-BK, see GN 00502.110. Faxed, mailed, or dropped off SSA-11-BK's are leads and you must follow up with a face-to-face, telephone, or VSD interview.

NOTE:

If the recipient dies before you process the SSA-11-BK completely, handle the form as incomplete, and notify the payee applicant of the action taken, see GN 01010.475 and GN 00502.110.

C. Description of entry or expected answer(s) for the SSA-11-BK (Page 1)

Use the following chart to determine what information you should expect in response to specific questions on page 1 of the SSA-11-BK and how to evaluate those answers SSA-11-BK

Question	Explanation
Heading	Enter appropriate payee coding, see SM 01601.565. NOTE: Payee coding is required for all beneficiaries when a representative payee is appointed. Enter the number holder's name and SSN and the recipient(s) name(s) and SSN(s).
1	Complete this question only when the recipient is applying to become their own payee and requesting direct payment.
2	Use in conjunction with other evidence of capability to decide whether the recipient needs a representative payee. Obtain information about: • how the recipient is handling any money now received, • how the recipient interacts with society, and • any other information that will help you determine the recipients ability to make reasonable judgments about managing their funds. NOTE: If direct payment is precluded, only state the precluding condition. Minor children—check the indicator block if the recipient is a minor child.
3	Obtain information about how the applicant shows interest in and demonstrates responsibility for the recipient. This will help you decide if the applicant is the best possible payee.
4	The information you receive to this question will help you decide whether the applicant is able to meet with the recipient(s) on a regular basis to ascertain their current and foreseeable needs.
5	Information received regarding legal guardians and conservators are necessary to identify third parties that must receive notice and possible higher payee preferences. ALERT: Appointment of a legal guardian by a court may indicate that the recipient is legally incompetent, see GN 00502.001C and GN 00502.130B.

D. Description of entry or expected answer(s) for the SSA-11-BK (Page 2)

Use the following chart to determine what information you should expect in response to specific questions on page 2 of the SSA-11-BK and how to evaluate those answers:

Question	Explanation
6	A recipients living arrangement may supply information relevant to your capability decision, indicate other potential payee sources, and identify the custodian.
7	The information you receive to this question may provide a lead to a candidate higher on the payee preference list, see GN 00502.105. A parent with custody of a minor child is generally the preferred payee for that child. NOTE: If the child(ren) is/are in foster care additional considerations are involved, see GN 00502.159.
8	Use the names obtained from this question as potential payee leads.
9	This serves to identify payee type (indicates if additional development is needed) and to determine which of the remaining questions the applicant must complete.

E. Description of entry or expected answer(s) for the SSA-11-BK (Pages 3 and 4)

Use the following chart to determine what information you should expect in response to specific questions on pages 3 and 4 of the SSA-11-BK and how to evaluate those answers:

Question	Explanation
10	The information provided will determine if the payee applicant is a creditor, see GN 00502.135.
11	Only institutions, agencies and financial institutions are required to answer this question. It will capture identifying information about the applicant's organization.
12	This will supply information about the applicant used to verify the applicant's SSN and identity. An SSN is required from an individual, see GN 00502.117. Do not request the SSN if the applicant is filing as an official representing an institution or organization. Instead, obtain the EIN of the institution/organization the applicant represents (question 11). For additional EIN information, see GN 00502.118 and MS 07414.002 Establish Organization/Institution screen.
13	The answer to this question will help you assess how long the applicant has known the recipient.
14	This will help you assess the applicant's suitability and may elicit other potential payee leads.
15	The information provided will help you evaluate the payee applicant’s income situation and may factor into how likely the applicant will use the benefits in the best interest of the recipient.
16	If the applicant gives permission to run a criminal background check, it will help you assess their criminal history when you use the eRPS Background Check screens. For further instructions on conducting a criminal background check and a list of payee applicants who are exempt, see GN 00502.113D.
17	Individuals convicted under Sections 208, 811, or 1632(a) of the Social Security Act cannot serve as payee. There are no exceptions. For additional instructions on the use of the answers to this question, see GN 00502.133.
18	The information obtained will help you determine whether the applicant is a fugitive felon. Section 103 of the Social Security Protection Act of 2004 provides that, effective April 1, 2005, fugitive felons are prohibited from serving as payee, see GN 00502.133A.2.
19	The length of time an applicant has lived in their current location may help you with assessing the applicant's stability in the community, a factor that bears on suitability as payee. However, you should obtain additional information about the situation surrounding the change of address to determine if it has any bearing on applicant's suitability. For an applicant who has merely changed their fixed address recently from another fixed address, change of address is not an indicator of unsuitability as payee. However, if an applicant changes residence frequently, the applicant may have no true fixed address. While this does not necessarily indicate the applicant is unsuitable, a transient lifestyle may raise some question about the applicant's suitability.

F. References

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MS 07401.001 eRPS Overview
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GN 00502.190 Processing Manual Representative Payee (Payee) Selections
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GN 00502.113 Interviewing the Payee Applicant
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GN 00502.110 Taking Applications in the eRPS
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MS 07409.001 eRPS Application Overview
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GN 01010.475 Abatements
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SM 01601.565 Representative Payee Data - REPY
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GN 00502.001 Capability Determination and Representative Payee Payment Overview
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GN 00502.130 Factors to Consider in Evaluating Payee Applicants
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GN 00502.105 Payee Preference Lists
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GN 00502.159 Additional Considerations When Foster Care Agency is Involved
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GN 00502.135 Payee Applicant is a Creditor
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GN 00502.117 Verifying Information Provided by Payee Applicants
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GN 00502.118 Verifying and Updating EINs for Organizational Payees
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MS 07414.002 Establish Organization/Institution
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GN 00502.133 Payee Applicant is a Felon or Fugitive or Has Been Convicted of Other Criminal Act

Social Security

Program Operations Manual System (POMS)

GN 00502.115 The SSA-11-BK, Request to be Selected As Payee