Form SSA-11-BK: A Representative Payee Guide

If you’re providing support for a Social Security beneficiary, such as a minor child, you may be able to request that the Social Security Administration direct payment of those Social Security benefits to you, instead. You can do this by filing Form SSA-11-BK: Request to be Selected As Payee.

How do I fill out Form SSA-11-BK?

The official Form SSA-11-BK is not on the Social Security website. There are copies of this form on other federal government websites. However, any copies of this form you see (including on this website) may not be the most updated version.

Even if there are new versions of the form, walking through this form might help you be prepared for your interview with the Social Security office. Whether you fill out Form SSA-11-BK or apply via ERPS, you should be prepared to provide documents that prove your identity, including either:

  • Proof of Social Security Number, if applying as an individual
  • Proof of employer identification number (EIN), if applying on behalf of an organization

Here are the important points for each section.

Items 1-5

Page 1 contains the beginning of the application. This section will contain the Social Security number for both the rep payee applicant and the claimant. This section also contains the full legal name of each person.

If you are applying as the rep payee on behalf of the beneficiary

Skip Item 1. Only the claimant should fill out Item 1. When you are the rep payee, you’ll complete items 2-5, with justification for each field.

If you are the court-appointed legal guardian or conservator

Include information regarding the circumstances of the appointment at the bottom of Page 1. Because this is not a separate line item, this section is easy to miss.

SSA-11-BK Page 1
If you’re a legal guardian, make sure you explain the circumstances of the appointment at the bottom.

Items 6-7

These sections contain more information about the living conditions and care of the claimant.

Form SSA-11-BK Items 6 & 7

Items 8-9

The bottom of Page two explores the relationship of any person or entity who may have provided support or shown an active interest in the claimant.

Form SSA-11-BK Items 8 & 9

Items 10-15

At the top of Page 3, the questionnaire asks about financial information, including:

  • Does the claimant owe money to the applicant?
  • If an institution is applying, name of the institution, as well as the institution’s EIN
  • Applicant’s main source of income (for example, the applicant’s own benefits from Social Security)
Form SSA-11-BK Items 10-15

Items 16 & 17

At the bottom of Page 3, the applicant gives permission for the Social Security Administration to conduct a criminal background check and asks about any felony convictions.

Form SSA-11-BK Page 3

Items 18 & 19

The top of page 4 asks for information on unsatisfied felony warrants (like date of the warrant and where the warrant was issued), as well as how long you’ve lived at your current address.

The remarks section is for any additional information you may need to provide to further explain any of the other fields.

Form SSA-11-BK Page 4

Signature Block

The signature block contains your sworn signature that the information you’ve given is accurate to your knowledge. It’s important to note that this is punishable under penalty of perjury. If there is proof that false information was provided, or that the applicant filed a fraudulent application, that person can be prosecuted by the United States government.

You’ll also enter:

  • Full legal name
  • Mailing address
  • Residence address (if different from mailing address)
  • Date
  • Telephone number
SSA-11-BK signature block

This is known as a representative payee, and may help you handle the finances of the beneficiary in a way that better serves their best interest. This article will walk you some of the details you need to know about Form SSA 11-BK, and how to become a representative payee.

What is a representative payee?

A representative payee is an individual or organization that the SSA has appointed to receive Social Security benefits or Supplemental Security Income payments (SSI) on behalf of a beneficiary who cannot manage their own finances.

This might include:

  • Legal guardian or adoptive parent of a minor child
  • Caretaker for an incompetent adult

In cases where a representative payee is appointed, the rep payee is expected to maintain detailed records to document that the Social Security payments were used on the beneficiary’s behalf.

Video walkthrough

Frequently asked questions

What Is Form SSA-11-BK?

Form SSA-11-BK is the legal form that must be completed if a representative payee application cannot be completed through the electronic Representative Payee System (ERPS). For example, an applicant without a Social Security Number must complete Form SSA-11-BK.

How do I become a representative payee?

Unlike most other Social Security forms, Form SSA-11-BK is not available online on the SSA’s federal government site. There is a huge potential for fraud impacting Social Security beneficiaries. Because of this, the SSA requires the representative payee to come to their local Social Security office. This allows a field office technician to conduct a face to face interview with the applicant.

During the face to face interview, the Social Security technician will determine whether your application can be processed through the electronic Representative Payee System (ERPS) or if Form SSA-11-BK must be filed.

Where can I find Form SSA-11-BK?

Most likely, you’ll be providing this information to the Social Security office, and your application will be filed electronically. If you have any technical questions, you should contact the local Social Security office or go to the representative payee home page on the SSA website.

For your convenience, the most recent version of this form is provided below.

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  1. Michael Neymit says:

    Thank you very much for this article! It’s very helpful. I do have a question. If I am applying to be a representative payee for my elderly mother, which has dementia, does she need to be present during the appointment at the Social Security Office?

    1. Forrest Baumhover says:

      I don’t believe your mother has to be present. However, you will need to have some proof or verification as to why you would be the logical payee. For example, proof of guardianship or conservatorship would probably help establish you as the representative payee. I would confirm this with the SSA when you are setting up the appointment, just as a precaution.

  2. Teresa Collins says:

    I am payee for a lady that has been scammed for last 5 years and is continuing to talk with scammer since I took over her funds in September 2023. I have been paying all of her bills that she had not paid since May and she was evicted for non payment of rent and lived in a motel for 2 months before I got her housing. She still owes a lot of money to creditors. She is asking for $100 to have for herself but won’t tell me why. I know that she said the scammer will be here the 15th but needs money to get here. I have texted scammer and he won’t talk to me now. Am I obligated to give her the $100 she is requesting. I get her check and pay balances down and I leave her $200 to pay for groceries and little things for the month. She does not drive at this time. What do I do?

    1. Forrest Baumhover says:

      That is a powerful question, and there are probably some legal aspects that I don’t think I could adequately discuss in an online setting. If I were in your position, I would probably do two things, to protect this person, and to protect yourself.

      1. Set up an appointment with the SSA to discuss this situation and see what they suggest. Moreover, you’re using this to document your position in the case any investigation comes up…as the representative payee, you can expect the SSA to look closely at your relationship in any situation where misuse of funds might be suggested.
      2. Set up an appointment with a bankruptcy attorney or pro bono lawyer for your client to discuss your client’s options.

      If your relationship is strictly a professional relationship (she is not personally related to you), I would also think about when you may decide to remove yourself from this situation..if she continues to give money to a scam artist, that’s her choice. However, you shouldn’t bear the additional stress of having that impact you (or weigh on you). For example, there were times when as a financial planner, I had to terminate client relationships when they got to the point where I felt that the client’s refusal to follow recommendations would lead to negative outcomes…that they might end up blaming me for.

      If your relationship is a personal one, you may need to see if there are cognitive issues at stake, or if a guardianship needs to be established.

      However, all of these things are considerations that I would make, not necessarily recommended courses of action.

  3. Ryan Brown says:

    This may be an obvious question to some but I don’t see it specifically addressed in the guide or the video.

    I am applying to be the Rep Payee for my grandson (for whom I am the guardian). Who is the “Number Holder” and who is the “Claimant”?

    1. Forrest Baumhover says:

      You may want to check with the SSA to be sure, but I believe that the ‘number holder’ would be the person whose earnings history your grandson’s benefits are based on (parent or grandparent). The claimant would be your grandson.

      1. Ryan Brown says:

        He receives benefits due to disability. So I guess he would be the number holder? But it seems that the number holder definitely is not the person applying to be the Rep Payee.

        1. Forrest Baumhover says:

          In that case, if he’s receiving benefits due to his own disability, then he would be the number holder. And unless Box 1 is checked (indicating that the number holder wants to receive their own benefits directly from the SSA), then the SSA will process the form as if the representative payee is a different person from the number holder. In this case, the presumption is that you’re in a position to handle his finances that he cannot handle on his own.