The Social Security Administration requires that we submit two forms in our application to be selected as Rep. Payee:
SSA-787: to be completed by a physician who has recently examined the client. Clinician must indicate that the feel a Rep Payee is necessary on pages 2 and 3
SSA-787 - Medical Source Opinion of Patient's Capability to Manage Benefits
SSA-827: authorization to disclose information to SSA, to be signed by client
SSA-827 - Authorization to Disclose Information to SSA
In order to expedite our application, please complete these forms and use the upload button below to submit with this referral.
Monthly income source(s) and amount(s)SSA $0.00* SSI $0.00* SSDI $0.00* MA SSP $0.00* Other $0.00*