Representative Payee Confidential Complaint

Note: this is a complaint to Disability Rights Washington and will assist us in potential investigations of rights violations. There is a federally mandated protection and advocacy system in every state and territory. If you do not live in Washington State, by submitting this complaint you are consenting to Disability Rights Washington sharing whatever information you provide here to the federally mandated protection and advocacy system in your state so they can consider investigating. This complaint is not a substitute for a complaint to the Social Security Administration (SSA).

What is your complaint about this representative payee?
Rep payee Name
First Last
State
Contact information:
Witness(es) name and contact information:
How many people do you think are served by this representative payee?
Your name (Optional)*
First Last
Email (Optional)

*We cannot follow up with you if you do not leave your name and email address. If you chose to share your name and contact information, we will only share it with another protection and advocacy agency if you are from their state or use it only to get in contact with you if we need more information about your complaint or have an update for you on any steps we may take in response to your complaint.
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Once you click the submit button, the above information will be submitted to Disability Rights Washington and you will be redirected to a link to the publication on how to change, remove or report a representative payee.

Do not use this form for emergencies. If you are experiencing an emergency, call 911.

Making a complaint does not create an attorney-client privilege with Disability Rights Washington.

If you would like self-help information to address this or other problems on your own, please visit our resource page and/or request technical assistance services.

Federal law allows DRW to keep the identity of informants confidential 42 C.F.R. § 51.45 (a)(1)(iii); 45 C.F.R. § 1326.28 (b)(1)(iii).