CM-910 Request to Be Selected as Payee – Fillable PDF Form

The CM-910 is the official request used by individuals who want to be appointed as a representative payee for Social Security or Supplemental Security Income (SSI) beneficiaries. This form must be completed, signed, and submitted to the appropriate Office of the Workers' Compensation Programs.

What Is the CM-910 Form?

CM-910 gathers essential information about the applicant, the beneficiary, and the proposed payee arrangement. It is required by the Department of Labor and reviewed by the district office that has jurisdiction over the beneficiary’s claim file.

How to Complete the CM-910 Online

Instead of downloading and editing the PDF in a separate editor, simply click the "Fill out this form" button on this page. The Formize PDF Filler app will load the fillable version, allowing you to type, check boxes, and sign directly in your browser.

Common Mistakes to Avoid

• Leaving any required field blank – the system will highlight missing information.
• Using an outdated version of the form – our page always hosts the latest official PDF.
• Signing with a scanned image instead of the electronic signature tool – Formize captures a legally acceptable e‑signature.

Where to Submit the Completed Form

After you finish and save the form, download the completed PDF and mail or fax it to the district office listed on the form’s instructions. Keep a copy for your records.

Frequently Asked Questions

Find quick answers to the most common queries about CM-910 below.