Form SSA-1588 Beneficiary Recontact Report

1588
Beneficiary Recontact Report

FORM APPROVED
OMB NO.0960-0502

Social Security Administration, P.O. Box 5888, Wilkes-Barre, PA 18767-5888
FORM DATE

Payee's Name and Address

BNC#

BIC

BENEFICIARY

RQC

DOEC

PC

TYPE

If change of address, correct and check box.

WHAT YOU NEED TO DO: Please read the enclosed instructions before you complete this report.
Then complete this report and send it to us in the enclosed envelope within 30 DAYS. IF YOU DO NOT
RETURN IT PROMPTLY, WE WILL STOP SENDING CHECKS TO YOU.

1.

►

a. Are you married?
b. Print your spouse's name (Last, First, MI)

MONTH

YEAR

YES

NO

►

d. Does your spouse receive Social Security
benefits?

►

e. Enter your spouse's Social Security number.

►

a. Do you have children living with you who receive

Social Security benefits?

NO

►

c. Enter the month and year you married.
Show the month and year in numbers.

2.

YES

SOCIAL SECURITY NUMBER

NO

YES

►

Answer YES if the child:
● lives with you, or
● is temporarily away, for example at camp,
school, or visiting a relative, and you expect
the child to return, or
● does not live with you but you make the important
decisions about the child's welfare.
b. Enter the date the child
►
stopped living with you.
Show the month, day, and year in numbers.

MONTH

DATE

YEAR

Anyone who knowingly makes or causes to be made a false statement or representation of material fact for use
in determining a payment under the Social Security Act, or knowingly conceals or fails to disclose an event with
an intent to affect an initial or continued right to payment, or submits or causes to be submitted any false
statement or document knowing the same to contain any misrepresentation of material fact, commits a crime
punishable under Federal law by fine, imprisonment, or both, and may be subject to administrative sanctions.
Form SSA-1588-SM (XX-20XX)

Beneficiary Recontact Report
INSTRUCTIONS FOR COMPLETING THE BENEFICIARY
RECONTACT REPORT
1. Use black ink or a No. 2 pencil to complete this report.
2. Keep your numbers and X’s” inside the boxes.
3. Try to make your numbers look like these.

►
If you are receiving mother’s/father’s benefits, answer as follows:
Question 1a. Answer “No” unless you remarried since you began receiving Social
Security benefits based on your deceased spouse’s Social Security number.
If you have remarried, answer “Yes” and remember to complete 1b through 1d. If
the person to whom you are currently married receives Social Security benefits,
complete 1e.
Question 2a. Answer “Yes” if you have a minor child under age 16 or a child
disabled since before age 22 in your care. Remember to sign and date the form
and return it in the envelope provided.
If you do not have a child in your care, answer 2a “No” and complete 2b. Sign and
date the form and return it in the envelope provided.

BE SURE TO RETURN THE FORM TO:
Social Security Administration
Wilkes-Barre Direct Operations Center
P.O. Box 5888
Wilkes-Barre. PA 18767-5888

Continued on the
Reverse

Form SSA-1588-SM (XX-20XX)

►

PRIVACY ACT STATEMENT

Collection and Use of Personal Information
Sections 202(g) and 205(a) of the Social Security Act, as amended, allow us to collect this information.
Furnishing us this information is voluntary. However, failing to provide all or part of the information
may prevent us from making an accurate and timely decision on your continuing eligibility and may
result in the loss of benefits.
We will use the information you provide to determine continuing entitlement to benefits. We may
also share this information for the following purposes, called routine uses:
• To a congressional office in response to an inquiry from that office made at the request
of the subject of a record; and
• To student volunteers and other workers, who technically do not have the status of
Federal employees, when they are performing work for the Social Security
Administration (SSA), as authorized by law, and they need access to personally
identifiable information in SSA records in order to perform their assigned Agency
functions.
In addition, we may share this information in accordance with the Privacy Act and other Federal laws.
For example, where authorized, we may use and disclose this information in computer matching
programs, in which our records are compared with other records to establish or verify a person’s
eligibility for Federal benefit programs and for repayment of incorrect or delinquent debts under these
programs.
A list of additional routine uses is available in our Privacy Act System of Records Notices (SORN)
60-0089, entitled Claims Folder Systems, as published in the Federal Register (FR) on April 1, 2003, at
68 FR 15784 and 60-0090, entitled Master Beneficiary Record, as published in the FR on January 11,
2006, at 71 FR 1826. Additional information, and full listing of all our SORNs, is available on our
website at www.ssa.gov/privacy.
Paperwork Reduction Act Statement - This information collection meets the requirements of
44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to
answer these questions unless we display a valid Office of Management and Budget (OMB) control
number. We estimate that it will take about 5 minutes to read the instructions, gather the facts, and
answer the questions. Send only comments relating to our time estimate above to: SSA, 6401 Security
Blvd, Baltimore, MD 21235-6401.

Form SSA-1588-SM (XX-20XX)