How to complete an SSA 11-BK (Step by Step)

To complete an SSA 11-BK, you will need to provide the following information:

• Name of the number holder
• Social security number
• Name of the person(s) for whom you are filing (claimant)
• Claimant’s social security number
• Indication if you are the claimant and what your benefits paid directly to you
• Explanation if you think the claimant is not able to handle his or her own benefits
• Explanation why you would be the best representative payee
• If you are appointed the payee, indicate you will know about the claimant’s needs
• Whether the claimant has a court-appointed legal guardian or conservator
• Name, address and date of appointment of guardian or conservator 
• Circumstances of appointment
• Claimant’s type of residence
• Names and relationships of any other people who live with the claimant
• Claimant’s residence address and phone number
• Whether you expect the claimant’s living arrangement to change in the next year
• Whether you are applying on behalf of minor child(ren) and you are not the parent
• Parent’s information and explanation of whether parent shows interest in child
• Names and relationships of other relatives or close friends with active interest in claimant
• Indication of your type of relationship to the claimant
• Whether the claimant owes you/your organization money now or will in the future
• Institutions, agencies, and banks applying to be the representative payee: name, EIN
• Individuals applying to be the representative payee: name, date of birth, social security number, another other names used, any other SSNs used
• Length of time you have known claimant
• If claimant lives with you, indicate who takes care of the claimant while you are away and their relationship to claimant
• Main source of your income
• Employer’s name and address
• Length of employment
• Whether you have ever been convicted of a felony, details of crime, sentence, release, probation
• Whether you have any unsatisfied felony warrant for your arrest
• Length of time at current address
• Signature
• Date
• Address
• Signature of witness