DOL Form CM-623S

View OWCP-DCMWC's Form CM-623S Online htm

Agency:

OWCP-DCMWC

Title:

CM-623S, Representative Payee Report

Form Description:

CM-623S, Representative Payee Report: Benefits may be paid to a representative payee on behalf of the entitled individual when the beneficiary is unable to manage his or her benefits. The Representative Payee Report form is used to collect information from the payee to assure that the beneficiary's needs are being met. The CM-623s is a short version of the CM-623 and is only completed by a relative living with the beneficiary who is the beneficiary’s representative payee.

OMB Control Number:

1215-0173