- 3 - 



PART B(to be completed by all banks) 



l.a) Would you be willing to forward to social security beneficiaries the 

 informational material that you might receive for them within one 

 week of your receipt of it? 



Yes 



No 



(50^IT 

 b) If no, please explain why not 



(50^0 



(51-M 



2. a) So that you might inform the Social Security Administration of the 



home address or death of a beneficiary would you distinctly identify 

 social security depositors in your records? 



Yes 



No 



(52-1) 

 b) If no, please explain why not 



(52-M 



( 53-14 ) 



3. 



4. 



Would you be willing to notify the Social Security Administration of 

 a beneficiary depositor change of home address within one week of your 

 knowledge of the change? 



Yes 



No 



(5U-1) ( 5 U-1») 



Would you be willing to notify the Social Security Administration of 

 the death of a beneficiary depositor within one week of your knowledge 

 of the death? 



Yes 



r5yr) 



No 



(55-M 



So that you might inform the Social Security Administration of possible 

 unreported deaths, would you be willing to periodically (at least 

 annually) provide them with those social security depositor accounts 

 in which there is no activity conducted by the beneficiary although 

 monthly social security payments are deposited? 



Yes, for the following types of accounts (please check all that apply) 



a) Individual Checking 



(57-1) 



b) Joint Checking 



(58-1) 



c) Individual Savings 



(59-1) 



d) Joint Savings 



(60*1) 



e) Trust 



(61-1) 



f) None 



(56-1*) 



(Please turn page over and complete other side) 



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