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View ESA-OWCP-DCMWC's Form 1215-0173 Online 
| Agency: |
ESA-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 |
| OMB Expiration Date: |
Friday, October 31, 2008
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