Representative Payee Report of Benefits and Dedicated Account

SSA requires payees to submit a written report accounting for the use of money paid to Social Security or Supplemental Security Income (SSI) recipients, and to establish and maintain a dedicated account for these payments. SSA uses Form SSA-6233-BK to: (1) Ensure the payee uses the payments for the recipient’s current maintenance and personal needs; and (2) confirm the expenditures of funds from the dedicated account remain in compliance with the law. Although we mail a paper Form SSA-6233-BK to the payee, the report can also be completed through telephone contact and then be mailed to the payee for signature, or during a face-to-face interview. The respondents are payees for SSI and Social Security recipients. We are making non-substantive changes to revise language on Form SSA-6233-BK, we are also reducing the Average Burden Per Response (minutes) from 20 minutes to 15 minutes, and we are revising the Privacy Act Statement.

The latest form for Representative Payee Report of Benefits and Dedicated Account expires 2026-04-30 and can be found here.