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.

b. Print your spouse's name (Last, First, MI)

NO

MONTH

YEAR

YES

NO

►

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

2.

YES

►

a. Are you married?

►

d. Does your spouse receive Social Security
benefits?

►

e. Enter your spouse's Social Security number.

►

SOCIAL SECURITY NUMBER

a. Do you have children living with you who receive

Social Security benefits?

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

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-1588-SM (XX-20XX)

Daytime Telephone Number (Include Area Code)

Date Signed

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

Please see Revised Privacy
Act Statement Attached

Collection and Use of Personal Information
Sections 202(g)(1) 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 could result in the loss of benefits.
We will use the information you provide to confirm continued entitlement to benefits.
We may also share this information for the following purposes, called routine uses:
1. To Federal, State, or local agencies (or agents on their behalf) for administering cash or
non-cash income maintenance or health maintenance programs; and
2. To contractors and other Federal agencies, as necessary, for the purpose of assisting the
Social Security Administration (SSA) in the efficient administration of its programs. We
will disclose information under the routine use only in situations in which SSA may enter
into a contractual or similar agreement with a third party to assist in accomplishing an
agency function relating to this system of records.
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, Claims Folder Systems, as published in the Federal Register (FR) on April 1, 2003, at 68 FR
15784 and 60-0090, Master Beneficiary Record, as published in the FR on January 11, 2006, at 71 FR
1826. Additional information, and full listing of all of 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)

SSA will insert the following revised Privacy Act Statement into the form as soon
as possible:
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.