Form

Report of benefits and Dedicated Account

This interview helps a parent or representative payee of a child on SSI keep track of money spent from a dedicated account with the child's retroactive SSI benefits.

More information:

• Social Security and SSI
• Original form

Can I use this interview?

You can use this interview to fill out a Report of Benefits and Dedicated Account or to keep track of what you spent. It can be used by:

• A parent, or
• A representative payee of a child or dependent who gets SSI

Before you start

Before you start, gather any records that show what you spent over the last year.

Include:

• The letter from Social Security that tells you the period of the report
• The amount of money in the dedicated account as of your last report to SSA
• The amount of money you deposited into the account since your last report to SSA
• The amount of money you spent from the account since your last report to SSA

Start interview