| Item 1 |
Complete. |
| Item 2 |
Enter first month and year for which payment is requested. When using TA 55, enter month and year of benefit payment being replaced (use a separate Form 552 for each month for which benefits are being replaced). |
| Item 3 |
Enter the correct TA. When reissuing a benefit payment which was voided, lost, stolen, or not received, enter TA 55. Attach a signed and completed Stop Payment and Recovery Agreement (Form 98) when you reissue a check upon which a stop payment order
is issued. TA 55, when used for payments due to appeal decisions, requires entries in Items 40 and 80. |
| Item 4 |
Enter a 2. |
| Items 5-6 |
Complete. |
| Items 8-10 |
Complete. |
| Item 28 |
Complete for GA. |
| Item 33 |
Complete. |
| Item 37 |
Complete for TANF. |
| Item 38 |
Enter total amount of payment being requested. This amount must be the same as the amount in Item 80. |
| REMARKS |
Enter appeal number located in right-hand corner of first page of Appeal Decision. Enter months covered by appeal payment and the number of Forms 552 used to authorize payment. |
| Item 40 |
Complete only when using TA 55. Enter the payment number, if available, the date and the amount of the payment being replaced. |
| Items 60-74 |
For TANF and GA, complete when using TA 34. |
| Item 77 |
Complete only when using TA 55. |
| Item 80 |
Enter code 150 (Appeal Decision Implementation) and amount. |