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NJ DCF Logo with reverse copy

 

New Jersey Department of Children and Families Policy Manual

 

Manual:

CP&P

Child Protection and Permanency

Effective Date:

Volume:

X

Forms

Chapter:

A

Forms

6-24-2013

Subchapter:

1

Forms

Issuance:

10.4

CP&P Form 10-4, Notification to SSA: CP&P Is No Longer Child’s Representative Payee

 

 

Click here to view, complete, and print the CP&P Form 10-4.

 

WHEN TO USE IT

 

Complete this form when a child, who is a recipient of a Federal government benefit, leaves CP&P-supported out-of-home placement (returns home, is adopted, KLG).

 

Federal Social Security benefits include:

 

      Retirement, Survivors, Disability, and Health Insurance Social Security Administration Title II benefits;

      Supplemental Security Income (SSI) benefits; 

      Veteran's Administration benefits; and

      Railroad Retirement Board benefits.

See policy, CP&P-IX-F-1-250, Federal Benefits.

 

HOW TO USE IT

 

The form is a "letter," prepared by the assigned Worker, given to the child's parent or caregiver for his or her action. The Worker advises the parent or caregiver to go to their local Social Security Administration office, in person, with this letter in hand, to notify the SSA that CP&P is no longer the representative payee for the child's Social Security benefits. The letter is designed to facilitate the parent or caregiver filing a claim for benefits on the child's behalf.

 

The Worker meets with the child's parent, adoptive parent, Kinship Legal Guardian, or designated caregiver in person, and gives them the form. The Worker provides a brochure, published by the Social Security Administration, explaining SSA/SSI benefits. The brochure is found at http://www.ssa.gov/pubs/EN-05-10026.pdf.

 

PROCEDURES TO DETERMINE IF THE CHILD IS A RECIPIENT OF A FEDERAL GOVERNMENT BENEFIT

 

Upon verifying that CP&P currently receives benefits on behalf of the child, complete the form. Follow these procedures to determine if the child is a recipient of a Federal government benefit: 

 

      Look up the client in NJ SPIRIT.

      Click on "Income/Eligibility." 

      Click on "Assets and Employment" tab.

      Under "Assets/Liabilities," see the child's Social Security or SSI benefits, if CP&P receives government benefits on behalf of the child, based on the child's out-of-home placement through CP&P.

TIPS FOR COMPLETING THE FORM

 

Print the form on CP&P letterhead.

 

      The assigned Worker completes the form, using the "Tab" key on the keyboard to complete the required text boxes.

      In the space provided, enter the number and date of the FN or FG court order that authorized return of the child home, finalized the adoption or KLG arrangement, etc.

      The assigned Worker and Supervisor sign the form.

DISTRIBUTION

 

Original          -           Parent/caregiver (to take to local SSA office)

 

Copy               -           Parent/caregiver (for their files)

 

Copy               -           Title IV-E Reviewer assigned to the Local Office

 

Copy               -           Local Office IV-E file

 

Copy               -           Case record