Basic (04-00)

VB 00501.010 Filing a Representative Payee Application

A. Policy

A paper SSA-11-BK must be completed for SVB, even when the applicant is currently serving as payee for the beneficiary's RSI/SSI payment. SVB is a new entitlement and therefore requires a new rep payee application and appointment decision. All representative payee applicants (those with SSNs and those who do not have an SSN) must complete a paper SSA-11-BK (Request to be Selected as Payee). The Representative Payee System (RPS) will not be used for SVB applications. RPS will not contain rep payee information for the title VIII program. Payee information will be on the San Francisco Intranet Site and the SSR.

1. SSA-11-BK

The SSA-11-BK has been revised (2/2000) to include new SVB payee reporting responsibilities. Use the new SSA-11-BK when someone applies to be a payee for a title VIII beneficiary. Conduct a face-to-face interview whenever practicable. (Refer to GN 00502.113, GN 00502.115, and GN 00505.010.) Explain the payee applicant's reporting responsibilities including accounting requirements. Give the new SVB payee reporting responsibilities to the payee applicant. If a new SSA-11-BK is not available, modify the prior version to include SVB by adding "SV" after "Black Lung" and before "benefits" in the bolded area on page 1. A copy of the Exhibit can be made in order to give the payee applicant the new SVB reporting responsibilities (pages 11 and 12 of the SSA-11-BK).




Information for Representative Payees Who Receive Special Benefits for WW II






  • the claimant DIES (special veterans entitlement ends the month after the claimant dies);

  • the claimant returns to the United States for a calendar month or longer;

  • the claimant moves or changes the place where he/she actually lives;

  • the claimant receives a pension, annuity or other recurring payment (includes workers' compensation, veterans benefits or disability benefits), or the amount of the annuity changes;

  • the claimant is or has been deported or removed from U.S.;

  • the claimant left a jurisdiction within the U.S. to avoid prosecution or custody or confinement after conviction for a crime that is a felony, or in New Jersey, a high misdemeanor;

  • the claimant is in violation of a condition of probation or parole.

In addition to these events about the claimant, you must also notify us if

  • YOU change your address;

  • YOU are convicted of a felony.


BENEFITS MAY STOP IF ANY OF THE ABOVE EVENTS OCCUR. You can make your reports by telephone, mail or in person. You can contact any Federal Benefits Unit (FBU) or the Regional Federal Benefits Office in the Philippines or any U.S. Social Security Office.




  • payments must be used for the claimant's current needs or saved if not currently needed;

  • you may be held liable for repayment of any payments not used for the claimant's needs or of any overpayment that occurred due to your fault;

  • you must account for benefits when so asked by the Social Security Administration. You will keep records of how benefits were spent so you can provide us with a correct accounting;

  • to let us know as soon as you know you are unable to continue as representative payee or the claimant no longer needs a payee.






Form SSA-11-BK (2-2000) Page 11
















Your request for Special Benefits for WW II Veterans on behalf of the individual(s) named below has been received and will be processed as quickly as possible.


You should hear from us within days after you have given us all the information we requested. Some claims may take longer if additional information is needed.


In the meantime, if you change your address, or if there is some other change that may affect the benefits

payable, you-or someone for you-should report the change. The changes to be reported are listed on the reverse.


Always give us the claim number of the beneficiary when writing or telephoning about the claim.


If you have any questions about this application, we will be glad to help you.




We are required by section 205(j) and 205(a) of the Social Security Act to ask you to give us the information on this form. This information is needed to determine if you are qualified to serve as representative payee. Although responses to these questions are voluntary, you will not be named representative payee unless you give us the answers to these questions.

Sometimes the law requires us to give out the facts on this form without your consent. We must release this information to another person or government agency if Federal law requires that we do so or to do the research and audits needed to administer or improve our representative payee program.

We may also use the information you give us when we match records by computer. Matching programs compare our records with those of other Federal, State or local government agencies. Many agencies may use matching programs to find or prove that a person qualifies for benefits paid by the Federal government. The law allows us to do this even if you do not agree to it.

Explanations about these and other reasons why information you provide us may be used or given out are available in Social Security offices. If you want to learn more about this, contact any Social Security office.


The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in accordance with the clearance requirements of section 3507 of the Paperwork Reduction Act of 1995. We may not conduct or sponsor, and you are not required to respond to, a collection of information unless it displays a valid OMB control number. We estimate that it will take you about 10.5 minutes to complete this form. This includes the time it will take to read the instructions, gather the necessary facts and fill out the form.


Form SSA-11-BK (2-2000) Page 12

2. Verifying Payee Applicant's Identity

An individual payee applicant's identity must be verified in all cases. Verify the payee's own SSN or EIN (if issued). Payees residing outside the U.S. may not have SSNs. Since SSA only issues SSNs to foreign nationals residing outside the U.S. in specific situations, we cannot require others to have an SSN as a condition of payee appointment. (Refer to GN 00502.117.)

B. Procedures -- processing a title VIII claim with representative payee involvement

1. Beneficiary currently eligible for title XVI and has a representative payee who will continue to serve

a. Completing the SSA-11-BK

If the current payee states that he/she will be moving outside the U.S. with the beneficiary and would like to serve as payee for the beneficiary's SVB benefits, complete a paper SSA-11-BK. (Refer to VB 00205.110.) Query the MBR to determine if the beneficiary has a payee for title II. Whenever possible, it is preferable to appoint the same payee for all types of benefits. Tear off the pages for SVB payees (pages 11 and 12), and give to the payee applicant. Keep the SSA-11-BK in the folder with the SSA-2000-F6 application. The selection of the payee cannot be done until the foreign residence has been established for both the beneficiary and the payee and the title VIII claim has been adjudicated.

Although there is no prohibition on having a domestic payee while the recipient resides outside the United States, it is very unlikely that selection of this person as payee would be in the best interest of the beneficiary. (Refer to GN 00502.130 and GN 00504.100.)

If a field office takes the SVB claim and the representative payee application, they should hold them until foreign residency has been verified and then forward the folder to the Central Processing Site (CPS) for processing. The CPS will adjudicate the claim, select the payee and issue notices. If the claim is filed in a FBU, and proof of residency has been established, they will forward to the CPS to adjudicate, select the payee and issue notices.

b. Updating RPS

Once the SVB claim has been adjudicated the title XVI relationship in RPS must be manually terminated by the CPS. Only terminate title XVI relationship records (this entitlement has ended); if there is a title II entitlement on RPS do not terminate it. (T33 actions will not automatically terminate the RPS record.) To terminate the RPS record, follow these steps:

  1. 1. 

    Go to RPS Main Menu

  2. 2. 

    Select 2 - Update, then select 8 - PE

  3. 3. 

    Select 6 -- Relationship Termination

  4. 4. 

    RPS will display all entitlements

  5. 5. 

    Select T-XVI

  6. 6. 

    Select 2 -- Beneficiary Entitlement Ceased

  7. 7. 

    Go to San Francisco's Intranet Site and input SVB rep payee information


Be sure to transmit a 1719B with new payee information (Refer to SM 01301.615.) It is very important to capture the new address information (input recipient's residence address in Remarks if they don't live with the payee since the RADR will have the CPS address) and have the Date of Selection (DOS) updated.

CPS will input SVB payee information into the Intranet site.

2. Beneficiary currently eligible for title XVI and has a representative payee who will not continue to serve

a. Completing the SSA-11-BK

If the current payee does not want to continue to serve as payee for SVB, document the file that once the recipient has established a foreign residence, payee development will be required. An SSA-11-BK must be taken from the new payee applicant in the country of residence (in most instances FBU will complete and develop for proper payee. See GN 00505.026 regarding development and selection of representative payees in the Philippines.) Fully review the payee reporting responsibilities and accounting requirements with the applicant. Give the payee applicant a copy of the reporting responsibilities and send the SSA-11-BK along with proof of foreign residence to the servicing FO. The FO will then transfer the SVB file to the appropriate CPS. (See VB 00901.010 and VB 00901.015).

b. Updating RPS

Following steps 1-7 in VB 00501.010B.1.b., terminate the title XVI relationship on RPS and input the SVB representative payee information into the Intranet Site. Be sure to transmit a 1719B with new payee information (refer to SM 01301.615). It is very important to capture the new address information (input recipient's residence address in Remarks if they don't live with the payee since the RADR will have the CPS address) and have the Date of Selection (DOS) updated.

CPS will input SVB payee information into the Intranet site.

C. Procedures -- PE actions

1. Policy

When a beneficiary who is in direct payment is no longer able to manage his/her benefits or protect his/her own interests, or a representative payee has died or is unsuitable, develop for a new payee as needed. If a new payee is not readily available, follow direct payment policy as described in GN 00504.105.

If an application to be selected as a payee is filed, and the beneficiary already has a payee, contact the current payee prior to making a change. In addition, contact the current payee when the beneficiary requests to receive his/her own benefits. In all cases, take an SSA-11--BK and follow representative payee policy as stated above.

2. Procedure

Use a SSA-1719B to process a payee change or if a new payee appointment is made (see VB 04005.001) to the SSR. Remember to update the Intranet site with new SVB payee information.

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VB 00501.010 - Filing a Representative Payee Application - 04/03/2000
Batch run: 04/15/2018