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Statement of Funds You Provided to Another Statement of Funds You Received
Forms SSA 2854 and SSA-2855 are used by SSA to collect information in situations where the SSI claimant alleges that money was borrowed on an informal basis from a noncommercial lender, e.g., a relative or friend, etc. These statements are completed by the borrower/claimant and the lender are required to determine whether the proceeds from the transaction are/are not income to the borrower/claimant. If the transaction constitutes a bona fide loan, the proceeds are not income to the SSI borrower/claimant.
Form #:  SSA 2854
Agency:  Social Security Administration
  TYPE PAGES SIZE (KB) CAPABILITY WHAT'S
NEEDED
paper Form Only 2   [1] Paper Only Other Client Software  

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