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November 4, 2008    DOL Home > Find It! By Form > DOL Form   

DOL Form CM-623

View ESA-OWCP-DCMWC's Form 1215-0173 Online htm
Agency: ESA-OWCP-DCMWC
Title: CM-623, Representative Payee Report
Form Description: CM-623, 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 CM-623 is used to collect information from the payee to assure that the beneficiary's needs are met.
OMB Control Number: 1215-0173
OMB Expiration Date: Friday, October 31, 2008




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