Form SSA-2855. Statement of Funds you Received

Form SSA-2855 is the Statement of Funds You Received. The main purpose of this form is to document and report any funds received by an individual or household, which may impact their eligibility for certain Social Security benefits. The form is used to ensure that individuals accurately report their financial situation, which is essential for determining benefit eligibility and payment amounts.

For example, individuals receiving Supplemental Security Income (SSI) may be required to report any funds they receive from various sources, such as gifts or inheritances. This form allows them to document these funds. The purpose is to maintain accurate records of financial transactions and evaluate their impact on SSI eligibility and payment amounts.

The parties involved are individuals receiving SSI and the SSA. The form consists of sections for the recipient's information, details about the funds received, and an explanation of the source of funds. Honest and accurate reporting is crucial to determine SSI eligibility and benefit amounts correctly.