Form SSA-1587-OCR-SM Beneficiary Recontact Report

1587
Beneficiary Recontact Report

FORM APPROVED
OMB NO.0960-0536

Social Security Administration, P.O. Box 5887, Wilkes-Barre, PA 18767-5887
Payee’s Name and Address

FORM DATE

SOCIAL SECURITY NUMBER

PIC

RIC

BENEFICIARY

RQC

DOB

PC

TYPE

If change of address, correct and check box.

WHAT YOU NEED TO DO: We need you to fill out this form because we have found that some children
do marry before age 18. We must stop payments to a child who marries. While we know that most
children do not marry before age 18, we need you to tell us if your child is married or not. If your child
has not married, we will continue to send payments.

1. A.

Has <> married?

YES

„

NO

If YES, go to question 1. B. BELOW.
If NO, STOP HERE. Sign and date the
form where indicated below.

1. B.

Enter the month and year the child married.
(Show the month and year in numbers.)
EXAMPLE: MAY 1994 > 05 1994

MONTH

YEAR

„

INSTRUCTIONS

• Use black ink or a No. 2 pencil to complete this report.
• Keep your numbers and “X’s” inside the boxes.
• Try to make your numbers look like these:

„
• Complete the report and send it to us in the provided envelope within 30 days.
Please return the entire form to SSA for processing.
I declare under penalty of perjury that I have examined all the information on this form, and on
any accompanying statements or forms, and it is true and correct to the best of my knowledge.
SIGN HERE

„

Form SSA-1587-SM (07-2007)

Daytime Telephone Number (Include Area Code)

Date Signed

Privacy Act/Paperwork Reduction Act Notice
Section 202(d) of the Social Security Act and regulations 20 CFR 404.703 and 20 CFR
404.705 authorize us to ask you to complete this report because you receive benefits for
a child under age 18. The child may continue to be entitled to benefits as long as he/she
is unmarried. We must ask you to complete this report on behalf of the child when he/she
receives Social Security benefits. Giving us the information on this report is mandatory.
Sometimes the law requires us to give out the facts on this report without your consent. We
may release this information to another person or government agency if Federal law requires
that we do so or to do the research and the audits needed to administer or improve our program.
We may also use the information you give us when we match records by computer. Matching
programs compare our records with those of other Federal, State, or local government agencies.
Many agencies may use matching programs to find or prove that a person qualifies for benefits
paid by the Federal government. The law allows us to do this even if you do not agree to it.
These and other reasons why information about the child may be used or given out are explained
in the Federal Register. If you want to learn more about this, contact any Social Security office.
See Revised PRA, Attached

This information collection meets the clearance 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 control number. We
estimate that it will take you about 3 minutes to read the instructions, gather the facts and
answer the questions. SEND THE COMPLETED FORM TO YOUR LOCAL SOCIAL
SECURITY OFFICE. The office is listed under U.S. Government agencies in your
telephone directory or you may call Social Security at 1-800-772-1213. You may send
comments on our time estimate above to: SSA, 1338 Annex Building, Baltimore, MD
Send only comments relating to our time estimate to this address, not the completed forms.

If You Have Any Questions
If you have any questions, call us at 1-800-772-1213. We can answer most questions over
the phone. If you prefer to visit one of our offices, please check the local telephone directory
for the office nearest you. Or call us and we can give you the office address. Please have
this letter with you if you call or visit an office. It will help us to answer your questions.

Form SSA-1587-SM (07-2007)

The following revised PRA Statement will be inserted into the form at its
next scheduled reprinting:
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 control number. We estimate that it will take about 3
minutes to read the instructions, gather the facts, and answer the questions. SEND THE
COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. The
office is listed under U. S. Government agencies in your telephone directory or you
may call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). You may send
comments on our time estimate above to: SSA, 6401 Security Blvd, Baltimore, MD
21235-6401. Send only comments relating to our time estimate to this address, not the
completed form.