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Social Security Administration fax number

(833) 950-3567

Representative Payee Program / Protective Payee Services (SSA office)

Used for: Fax SSA-787 Medical Source Statement to SSA for protective payee application; SSA-787 is used to determine need for a representative payee.

Fax destination details

Department
Representative Payee Program / Protective Payee Services (SSA office)
Purpose
Fax SSA-787 Medical Source Statement to SSA for protective payee application; SSA-787 is used to determine need for a representative payee.
Form
SSA-787 — Physician's/Medical Officer's Statement of Patient's Capability to Manage Benefits
Address
Social Security Office, 455 SW 5th St Ste F, Riverpoint Ofc Complex, Des Moines, IA 50309
Voice phone
+1-866-964-7583

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Form completed by the patient's physician/medical officer detailing the patient's capability to manage benefits and the justification for needing a payee.

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