You must show BOTH that the overpayment was not your fault AND that repayment would cause financial hardship

Request the waiver as soon as you receive the overpayment notice — do not delay

If the waiver is denied, you can appeal within 60 days

Social Security Disabilitymoderate

Request to be Selected as Payee

SSA-11-BK · SSA

Application to become a representative payee to manage SSI/SSDI benefits for an incapable beneficiary. Usually requires a face-to-face interview with SSA.

Form Details

Total fields: 45
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Filled by: caregiver
Frequency: one time

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Where to Submit This Form

🌐

SSA.gov

https://www.ssa.gov/forms/ss-11.html

Download and complete, then submit to SSA.

📬

Mail to your local SSA office

https://secure.ssa.gov/ICON/main.jsp

🏢

In person at local SSA office

https://secure.ssa.gov/ICON/main.jsp

Required Attachments

📎 Documentation of the overpayment notice from SSA
📎 Financial information (income, expenses, assets) supporting inability to repay
📎 Evidence that the overpayment was not your fault

Processing Time

30-90 days for SSA to make a waiver determination.

What Happens Next

SSA will review whether you were at fault for the overpayment and whether repayment would deprive you of necessary living expenses. Benefits may continue without reduction while the waiver is pending.

Tips for This Form

✓ You must show BOTH that the overpayment was not your fault AND that repayment would cause financial hardship
✓ Request the waiver as soon as you receive the overpayment notice — do not delay
✓ If the waiver is denied, you can appeal within 60 days

More Social Security Disability Forms

SSDI Application

SSA-16-BK · SSA

Application for Social Security Disability Insurance Benefits. Requires detailed work history, earnings record, and medical condition documentation.

SSI Application

SSA-8000-BK · SSA

Application for Supplemental Security Income for aged, blind, and disabled individuals with limited income and resources. Must be completed via SSA interview.

Adult Disability Report

SSA-3368-BK · SSA

The most complex patient-facing disability form. 15 pages requiring complete medical history, all diagnoses, medications, treating providers, hospitalizations, and work history.

Work History Report

SSA-3369-BK · SSA

10-page report requiring detailed descriptions of all jobs held in the past 15 years including physical demands, tools used, supervision, and lifting requirements.

Function Report

SSA-3373-BK · SSA

10-page functional assessment covering ADL capacity, daily routines, social functioning, cognitive abilities, and physical limitations.

Authorization to Disclose Information

SSA-827 · SSA

Authorization allowing SSA to collect medical and other information from providers, hospitals, and other sources for disability determination.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the SSA or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.