Return completed form to: 



Social Security Administration 

 Direct Deposit Study Group 

 6401 Security Boulevard 

 4R21 Operations Building 

 Baltimore, Maryland 21235 



FINANCIAL ORGANIZATION QUESTIONNAIRE 



PLEASE READ BACKGROUND INFORMATION BEFORE 

 ANSWERING QUESTIONS 



Do you now receive Treasury checks for deposit under powers of attorney 

 for social security beneficiaries? 



If yes, please complete parts A and B Yes 



•from 



If no, please complete part B No 



(UO-U) 

 If unknown, please complete part B Unknown 



CtQ - 6) 



PART A (to be completed by banks receiving checks under powers of attorney 

 for social security beneficiaries.) 



l.a) Is it your current practice to forward to a depositor the social 

 security informational material received as inserts with benefit 



With Credit Notice (1*3-2) 



With Monthly Account Statement (1*3-3) 



With Quarterly Account Statement (1*3-5) 



In a Separate Mailing (1*3-6) 



Held for Customers at Bank (1*3-7) 



Other (please specify) 



lh2=9) 



(Please turn page over and complete other side) 



-40= 



