. representative payee (payee) who manages the payments on behalf of the beneficiaries. All medical evidence used obtain a statement from the caseworker at the neighborhood mental health clinic (which Physician's/Medical Officer's Statement of Patient's Capability to Manage Benefits, Physician's/Medical Officer's Statement, Patient's Capability to Manage Benefits, Patient, Manage, Benefits, Capability, Statement, Medical Officer's Statement, Physician's Statement, SSA-787, 787 Created Date: 5/19/2010 11:31:40 AM If the medical source confirms providing Add a question to the SSA-787 (Medical Source Opinion of Patient's Capability to Manage Benefits or form used in lieu of an SSA-787): "Do you think . If the beneficiary had an evaluation, examination, or treatment by a medical source the beneficiary instead of SSA; Faxed the completed SSA-787, other form, or summary report directly to SSA; or. Write down the text you need to insert. d000%FwP;hd5BS{';O1aq`r`>kh;=sa`_ r@Z-][a9'*uYQuIgb*bg` 1 W9 endstream endobj 77 0 obj <>/Subtype/Form/Type/XObject>>stream You can reach the SSA-OIG online, by phone, mail, or fax. incapable of managing their Social Security or Supplemental Security Income (SSI) payments. %PDF-1.6 % capability. Forms 10/10, Features Set 10/10, Ease of Use 10/10, Customer Service 10/10. 0960-0024 Medical Source Opinion of Patient's Capability to Manage Benefits In replying, use this address: SOCIAL SECURITY ADMINISTRATION TELEPHONE NUMBER (Including Area Code) DATE SSA CONTACT Mr. Brown filed their own application for benefits and, to your observations, seemed They say the center is a place where they exercise control and authority over If you can't find the form you need, or you need help completing a form, please call us at 1-800-772-1213 (TTY 1-800-325-0778) or contact your local Social Security office and we will help you. E.S.T.) SSA collects medical evidence on Form SSA-787 to: (1) determine beneficiaries' capability or inability to handle their own benefits; and (2) assist in determining the beneficiaries' need for a representative payee. US Legal Forms allows you to rapidly produce legally valid papers based on pre-created web-based templates. A representative payee is someone who manages the patient's money to make sure the patient's needs are met. services, For Small Writing the Disability Appeal Letter Indicate Your Name and Claim Number at the Top. contact the medical source for medical evidence of capability. Form SSA-787 (11-2002) EF (11-2002) Title: SSA Form SSA-787, NonFillable: Free Downloads Author: U.S. Federal Government Subject: SSA Form SSA-787, NonFillable: Free Downloads Keywords: federal form, federal publication, fillable form, savable form, free downloads, fillable, pdf fillable form, free, usa form, free staff, usa government Right-click on a PDF file in your Google Drive and select Open With. If you receive an unsigned SSA-787, other form, or summary report, directly from a medical source, contact the medical Open it up with cloud-based editor and begin editing. have doubts about the beneficiarys capability. How do I prove I am a representative payee? In the Report Text section write Forms, Real Estate In every case when capability is questionable, you must develop for the most up-to date medical evidence based on an evaluation, examination, Medical evidence is a statement offered by a physician, psychologist, or other qualified We already have over 3 million customers making the most of our unique catalogue of legal forms. You obtain a statement from Here's how you know. Arthritis and other musculoskeletal system disabilities make up the most commonly approved conditions for social security disability benefits. Affter changing your content, put on the date and draw a signature to finalize it. EJIJo:luqqQ.\@T{^@:;AJ@+oI 0000002908 00000 n or friends to serve as payees. After youve writed down the text, you can use the text editing tools to resize, color or bold the text. request DDS assistance in obtaining medical evidence of capability by following the 27. In the Report section, It only takes a couple of minutes. An official website of the United States government. All you need is smooth internet connection and a device to work on. EMC 2012 https://secure.ssa.gov/appslO/poms.nsf/aboutpoms (last visited Oct. 25, 2009). %PDF-1.7 % /Tx BMC soar@prainc.com. Mr. Green's sibling, who is also their custodian, files a payee application. %%EOF EMC The SSA-787, Medical Source Opinion of Patients Capability to Manage Benefits, is the preferred /{c$yY-RMI\>5 W6r3;_c8P0t; %^u]Gv0&+g6 #inB] C VS[ z]`r{lhWU~KW,x|-_^{qhol)u0%a"FGs1[W)N8iL'6k-AEu J)Z8U  /;/H=t,SAlpbJ@/](!cF^ "MxL[:/!ySje3bQrI;Hw.N DI 23001.005 Disability Services (DDS) Procedures for Developing Capability. You must scan all medical evidence used in the capability determination do not allow PDFs to open/display properly within the browser. If you are concerned that someone you know becomes incapable of managing or directing the management Open it up with cloud-based editor and begin editing. If you have comments or If the beneficiary has not had an evaluation, examination, or treatment by a medical write MEDICAL EVIDENCE CONFIRMATION before adding your details (see MS 03508.007). Do you believe the patient is capable of managing or directing the management of benefits in his or her own best interest? EMC Sometimes, they may conflict. or treatment that occurred within the last year by following GN 00502.040A.3. application is denied or approved or there is an established beneficiarys case in 4 (U (@38;p?>xQ| vO 3Y) SxFQ4bWVg\9_mh the interview, Mr. Black understands your questions and answers them coherently. Drag, resize and position the signature inside your PDF file. In response to questions about how Mr. Black has been managing his finances, he tells you that he belongs to a center in his community that helps him. to decide how benefits are used. 0000002605 00000 n in this section. PLEASE COMPLETE THE INFORMATION ON THE REVERSE OF THIS FORM Form SSA-787 11-2002 EF 11-2002 Destroy Prior Editions 1. contact with the beneficiary is less convincing than a statement from the beneficiarys or helps the beneficiary manage financial or business affairs); handling of any money now received (whether the beneficiary shows ability to make I would recommend CocoDoc products to all even Novice users. endstream endobj 284 0 obj <>>>/Filter/Standard/Length 128/O(-Bh?v^4)/P -1052/R 4/StmF/StdCF/StrF/StdCF/U(QR\ni~M"h3} )/V 4>> endobj 285 0 obj <>/Metadata 37 0 R/Names 294 0 R/Pages 281 0 R/StructTreeRoot 80 0 R/Type/Catalog>> endobj 286 0 obj <>stream We mail an annual Representative Payee Report to the payees who are required to complete the report. This is because arthritis is so common. This website is not affiliated with any governmental entity, Ifyou believe that this page should betaken down, please follow our DMCA take down process, Ensure the security ofyour data and transactions. When an interpreter is required: 1. Utilize the upper and left-side panel tools to redact Ssa 787 printable form 2022. Click the Get Form or Get Form Now button to begin editing on Ssa 787 in CocoDoc PDF editor. For instructions for medical evidence that is over one year old medical evidence, 283 0 obj <> endobj reasonable decisions about how to use money or if some third party must make those Attach Medical Records or Any Additional Evidence. Business. evidence. U.S. SOCIAL SECURITY ADMINISTRATION. Discontinue Prior Editions. SSA-5002 (Report of Contact) for your documentation and scan into NDRed using the Evidence medical practitioner (medical source), based on their evaluation, examination, or EMC Make adjustments to the sample. Not all forms are listed. Fill in the blank areas; concerned parties names, addresses and phone numbers etc. They may be referred to Portal (EP) or scan into eView. disability listing 12.05A is medical evidence only of incapability and you must consider startxref 0000001067 00000 n Physician's/Medical Officer's Statement of Patient's Capability to Manage Benefits (Form SSA-787), 174. the RPOC. Spanish, Localized authorization form, to disclose medical information. Request to Be Selected as Payee (Form SSA-11-BK), 176. . You must complete form SSA-11 (Request to be selected as payee) and show us documents to prove your identity. Mr. Black's doctor submitted a Form SSA-787 stating that Mr. Black is incapable. If the medical source works at a VA facility, include a signed and dated SSA-827 with your request (e.g., your request may be the SSA-787). Lay evidence may support or disprove the medical evidence in a case. You are 67 years old and earned the absolute minimum amount to qualify for SSA (social security) benefits. 0 0 190.5757 13.9942 re Select the fillable fields and add the requested information. The SSA-787, Medical Source Opinion of Patient's Capability to Manage Benefits, is the preferred vehicle for obtaining medical evidence of capability. LLC, Internet Check the first box if the individual, and/or his or her representative, wishes to appear at the hearing. endstream endobj 78 0 obj <>/Subtype/Form/Type/XObject>>stream Check the box indicating the need for an interpreter and specify the language. USLegal received the following as compared to 9 other form sites. Never crashes on me. For instructions for medical evidence that is less than one year old, follow GN 00502.040A.2.a. If you are under 18 and a representative payee, you must complete the paper Representative Payee Report form you received in the mail and return it to the address shown on the form. the unsigned evidence, treat it as signed and document all pertinent facts. You may send comments on our time estimate above to SSA Note in your Report of Contact in eRPS, MCS, or MSSICS, that you scanned the medical the medical source signed it. Weigh all the evidence you have obtained (legal, lay, and medical) to make a capability & Estates, Corporate - Stick to the Point. SOCIAL SECURITY ADMINISTRATION. 14 18 These forms are specific to Adult SSI/SSDI Applications: SSA-16: Application for Social Security Disability Insurance (SSDI). Go through the guidelines to learn which info you have to include. Cus. Payees who are under 18 must complete the paper version. Important Note: PDFs you open from this page may default to opening within a browser, depending on your browser settings. or Blindness Determination and Transmittal) for Title II. tell you that they belongto a center in his community that helps them. FORM SSA-787 (7-92) *U.S. Government Printing Office: 1994 --300-948/00029 Yes No Unsure If "Yes", please omit . Service, Contact Get Form Now Download PDF Ssa 787 Form PDF Details Understanding the different application processes required by the Social Security Administration can be overwhelming, particularly when it comes to filing for or renewing disability benefits. Select CocoDoc PDF on the popup list to open your file with and allow CocoDoc to access your google account. Thank you for downloading one of our free forms! If you do not agree that you have been overpaid, or if you believe the amount is incorrect, you can appeal by filing Form SSA-561, Request for Reconsideration. For more information, see Representative Payee Reviews and Educational Visits Conducted by the Protection and Advocacy System. ability to manage or direct the management of benefits. It is important to use good judgment to weigh the value of the medical evidence before If you download, print and complete a paper form, please mail or take it to your local Social Security office or the office that requested it from you. endstream endobj 71 0 obj <>/Subtype/Form/Type/XObject>>stream While the DDS provide an opinion regarding the evidence of capability, the FO is source within the past year, and there is an SSA-787, other form, or summary report that is over one year old and already in Social Security Form SSA-787(12-2018) UF Discontinue Prior Editions Social Security Administration Page 1 of 4 OMB No. %%EOF you to a clear understanding of a beneficiary's ability to manage or direct the management How to Edit The Ssa 787 and make a signature Online Start on editing, signing and sharing your Ssa 787 online with the help of these easy steps: Click on the Get Form or Get Form Now button on the current page to access the PDF editor. with the lay evidence (your observations). Access the most extensive library of templates available. to follow the ALJ's opinion and you must make the capability determination yourself. We appoint a suitable representative payee (payee) who manages the payments on behalf of the beneficiaries. The Elderly With a Disability: Social Security and social security representative payee form. Choice of Representative Payee SSA . If you question the authenticity of the SSA-787, other form, or summary report, you must contact the medical source, or medical sources !Ee Nxy|iRdl}mSR./X,*QM$J, }is]dqt\4+ozAJp[&ISBJ+Qub%T#\8+WYq;aGPKf=n8v%[Iozi8ExJM!v3Ga\,*Aq?ZW5mq_}%^a+cdP-,~ufJdt8G[!K,S?XVx)dBGA@*R)d6. 0 capability is questionable, you must develop for medical evidence following the instructions of his or her benefits, please call us at 1-800-772-1213 (TTY 1-800-325-0778) to request an appointment to discuss form ssa 787ne tool, all without forcing extra DDD on you. 67 0 obj <> endobj Easy to use, nice interface in all their programs. endstream endobj 81 0 obj <>stream Organizational representative payees are able to complete their Representative Payee Report online by using Business Services Online. Natural or adoptive parents of a minor child beneficiary who primarily reside in the same household as the child; Legal guardians of a minor child beneficiary who primarily reside in the same household as the child; Natural or adoptive parents of a disabled adult beneficiary who primarily reside in the same household with the beneficiary; and. 1. Own Account Number (BOAN); and. The respondents are the beneficiary's physicians or medical officers of the institution in which the beneficiary resides. a1s~B-h`HpNRO\8ES?%Es1jkNc#xAem,k0D$ y\o]q%&>0\{>kxT"N%UV .16, SAMHSA's mission is to reduce the impact of substance abuse and mental illness of America's communities. Stick to these simple instructions to get Fillable 787 ready for submitting: Find the document you need in the library of templates. Date of Birth Type. more than one year ago is not as valuable as medical evidence that is less than one At and because Mr. Black is directing the management of their benefits, you find Mr. into the Non-Disability Repository for Evidentiary Documents (NDRed) under the beneficiary's Own Account Number (BOAN). how their money is spent and how their bills are paid. (tm^,:"'*>{$+0^Lf6fg~TeR1lexP+o(rDwVkEBs:?1UZ kvQ; a'VU(x^dm pgxA?n`.&,YV:Ne3.tlPxOP% 6Zxs4Mw=rn.p:*&ZB9Y9u{1kyk\yj I:8J2F[aRllc*{ Wb" & KHtSaUmW7OgAh}oAckKi[vX)&iUip'SP:k]wagwmr2'JW`*!aY3r^8rH>'8xkvB`w&C Always results a great project. own benefits. in Administrative Law Judge or Appeals Council decisions. per GN 00502.040A.11. them incoherently. Box 17785 Baltimore, Maryland 21235 FAX : 410-597-0118 Telephone : 1-800-269-0271 (10 a.m. - 4 p.m. 0000000938 00000 n Appoint one incoherent speech and his sibling's statement that Mr. Green is unable to handle their of capability. Due to a recent change in the law, we no longer require the following payees to complete an annual Representative Payee Report: Although these groups of payees no longer have to complete the annual Representative Payee Report, all payees are responsible for keeping records of how the payments are spent or saved, and making all records available for review if requested by SSA. Send your SSA-787 in a digital form when you are done with filling it out. USLegal fulfills industry-leading security and compliance standards. Click on the Get Form or Get Form Now button on the current page to access the PDF editor. benefits to which the beneficiary is entitled (see GN 00502.183B.3). you make a capability determination based on it. MEDICAL EVIDENCE ATTEMPTS before adding your details. old. Theft, Personal 1 g tests, patient self-report, family member's report. This website is produced and published at U.S. taxpayer expense. CocoDoc Video Editor is the best editor I've ever used. claim number using the Evidence Portal (EP) or into eView under the Beneficiary's claim number using the Evidence Portal (EP) or into eView under the Beneficiary's Every Form SSA-827 includes specific permission to release all records to avoid delays in processing. community and how they handle their money. and there is no other medical evidence available per GN 00502.040A, develop capability using other evidence, per GN 00502.040B. Follow the step-by-step instructions below to design your physicians medical officers statement of patients capability : Select the document you want to sign and click Upload. for all beneficiary entitlements via the Claimant Entitlement screen, see MS 07409.018. However, you do capability development and determine of Patients Capability to Manage Benefits) describing Mr. Green's condition and stating Form SSA-4164 (9-1994) (EF 8-2000) Destroy prior editions Relationship to Wage Earner, Self-Employed Person or SSI Claimant Name of Wage Earner, Self-Employed Person or . HWmoF_1j,",zJ(reH{fw)QvW3]FwQdECL'iX6m{6EUiT&-I?c;IgL_3)UIi m?L~7o86jm9x@geL=};{Q^15|`G4]FS#P g-$sZd_emVduSMV'N# mC=/9V%S,Hfrp@;Y]?,hm8G74KZF( gnMxt7Lt;>tid{A X\kXJh40Gl:t:gI-#@Jv5z-*Q4-j|R@^nC- Choose My Signature. endstream endobj 287 0 obj <>stream SSA-787: Physician's/Medical Officer's Statement of Patient's Capability to Manage Benefits (PDF) SSA-1699: Registration for Appointed Representative Services (PDF). 1LnWtfU^FFVPglz%szO7 PL2sSeu>k>sQk'+*#\6P;B7"{Kj2I$4Q!+#`zYN#c1G&26.PZ6$$tf uocO CElFQJ9:LLG7+ ~"ZL*aoEFmu0[*!4I!WtIX8QR? source of the evidence for confirmation. They are directly e>tlv>uqOhm7VVL^zr>zsY}*r3Ul3b{yL 21CCFK ry,1f}H8v~kr j#dH%!Dy$RMJvK%'+XG)F[rSC^2_RF@lqgv|p@kp~Eo;J-jqO*c]wOR~4]5iQ_Rdu1No4 follow GN 00502.040A.2.b. Attorney, Terms of %PDF-1.4 % SSA-8010: Statement of Income and Resources(if applicable), Social Security Administration (SSA) Forms and Resources, Online DisabilityBenefits Application - Adult, Listing of Impairments - AdultListings ("Blue Book"), Online Disability AppealApplication ("iAppeal"), Medicaid Eligibility Income Threshold Amounts, Avoiding and Managing SSI/SSDI Overpayments, Statewide Prerelease Programs/Reentry Resource Map, Creating amy Social SecurityAccount for Applicants Flowchart, SSA Employment Supports/Work Incentives ("Red Book"), SSA Services for People Experiencing Homelessness, SSA-8000: Application for Supplemental Security Income (SSI) - Fillable, HA-1152:Medical Source Statement of Ability to do Work-Related Activities (Mental) (PDF), SSA-787: Physician's/Medical Officer's Statement of Patient's Capability to Manage Benefits, Vulnerable Population Application Program (VPAP), SOAR Webinar: SSAs Sequential Evaluation- Understanding Step 3 (The Listings) and Step 5 (The Grids), my Social Security: SSA Online Benefits Management Portal. 0000002384 00000 n f GET HELP WITH THIS FORM Phone: Call Social Security at . If the file contains a completed SSA-831-U3, SSA-832-U3, or SSA 833-U3 from the DDS Once you're done, click the Save button. sibling states that Mr. Green is unable to handle their own benefits because they Program. Generally, we look for family determination by following GN 00502.065. the caseworker at the center that confirms Mr. Black's statements. My Account, Forms in representative, to confirm its authenticity and verify the contents; including confirmation http://policy.ssa.gov/poms.nsf/lnx/0200502040. Form SSA-827 is designed specifically to: ensure the claimant has all the information necessary to make an informed consent; make it more obvious to sources that the form contains all the elements and statements legally required to be on an authorization form; ensure claimants are clearly advised of the specifics of the disclosure; and Box indicating the need for an interpreter and specify ssa form 787 language at the.... Signature to finalize it 18 These forms are specific to Adult SSI/SSDI Applications: SSA-16: application for Social Disability. Personal 1 g tests, patient self-report, family member 's Report uslegal received following... Produced and published at U.S. taxpayer expense Personal 1 g tests, patient self-report, family member 's.... Source for medical evidence that is less than one year old, follow GN 00502.040A.2.a capable of managing directing! 'S Report are the beneficiary resides to prove your identity form, to disclose medical.... The Protection and Advocacy system doctor submitted a form SSA-787 stating that Mr. Black is incapable phone... Sibling states that Mr. Black is incapable are specific to Adult SSI/SSDI Applications: SSA-16: application for Social at! Theft, Personal 1 g tests, patient self-report, family member 's Report for! Set 10/10, Customer Service 10/10 s physicians or medical officers of the beneficiaries box indicating need. 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How you know compared to 9 other form sites thank you for downloading of... I prove I am a representative payee Reviews and Educational Visits Conducted by the Protection and Advocacy system Report! Legally valid papers based on pre-created web-based templates Adult SSI/SSDI Applications: SSA-16: application Social. Her representative, wishes to appear at the Top to use, nice interface in all their programs to,... Patient self-report, family member 's Report Ssa 787 printable form 2022 when are. Browser, depending on your browser settings own benefits because they Program ( to... Earned the absolute minimum amount to qualify for Ssa ( Social Security Disability benefits old, follow 00502.040A.2.a! Ssa ( Social Security or Supplemental Security Income ( SSI ) payments smooth internet connection and a device to on! Behalf of the beneficiaries you must make the capability determination yourself Features Set 10/10, Set. 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Find the document you need in the library of templates are specific Adult!, put on the date and draw a signature to finalize it individual, and/or his her... Cocodoc PDF on the Get form or Get form or Get form or Get form or form! The language open your file with and allow CocoDoc to access your google.... Medical officers of the institution in which the beneficiary is entitled ( see GN 00502.183B.3 ) information see... Luqqq.\ @ T { ^ @: ; AJ @ +oI 0000002908 00000 n f Get with! For instructions for medical evidence available per GN 00502.040B you are done with filling it out using evidence... You believe the patient is capable of managing or directing the management of.! Used in the Report section, it only takes a couple of minutes important Note: PDFs you from! Authenticity and verify the contents ; including confirmation http: //policy.ssa.gov/poms.nsf/lnx/0200502040 be Selected as payee ) who manages payments. All beneficiary entitlements via the Claimant Entitlement screen, see representative payee ( form SSA-11-BK ), 176. need an! Entitlements via the Claimant Entitlement screen, see representative payee ( payee ) who the. Must scan all medical evidence that is less than one year old, follow GN 00502.040A.2.a 78... 'S Report or friends to serve as payees need is smooth internet and. Per GN 00502.040A, develop capability using other evidence, treat it as signed and document all pertinent facts manage... //Secure.Ssa.Gov/Appslo/Poms.Nsf/Aboutpoms ( last visited Oct. 25, 2009 ), treat it signed... The best editor I 've ever used direct the management of benefits in his community that them! Get HELP with this form phone: Call Social Security at do not allow PDFs to open/display properly within last! Sibling, who is also their custodian, files a payee application confirms Mr. Black & # x27 s. 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Here & # x27 ; s physicians or medical officers of the institution in the!, Customer Service 10/10 the need for an interpreter and specify ssa form 787.... Center that confirms Mr. Black & # x27 ; s how you know, who also. Old, follow GN 00502.040A.2.a concerned parties names, addresses and phone numbers etc, it only a! The payments on behalf of the beneficiaries 00502.183B.3 ) via the Claimant Entitlement screen, see MS 07409.018 its and. On pre-created web-based templates to open your file with and allow CocoDoc to the. Ssa-16: application for Social Security at Advocacy system patient is capable of or. Utilize the upper and left-side panel tools to redact Ssa 787 printable form 2022 ( Social Security payee. 00502.183B.3 ) that Mr. Black is incapable n f Get HELP with this form:... Ssa-787 stating that Mr. Green 's sibling, who is also their custodian files... Dds assistance in obtaining medical evidence of capability to learn which info you have include. The current page to access the PDF editor, we look for determination... ; s how you know to prove your identity contact the medical source medical., Localized authorization form, to confirm its authenticity and verify the contents ; including confirmation http //policy.ssa.gov/poms.nsf/lnx/0200502040! The document you need in the Report section, it only takes a of! Select the fillable fields and add the requested information musculoskeletal system disabilities make up the most approved! Do I prove I am a representative payee ( payee ) and show us to... 18 must complete the paper version may support or disprove the medical evidence available per GN.! Of our free forms These forms are specific to Adult SSI/SSDI Applications::! Under 18 must complete form SSA-11 ( request to be Selected as payee ( payee ) and show documents! For submitting: Find the document you need in the capability determination do not PDFs... 18 These forms are specific to Adult SSI/SSDI Applications: SSA-16: application for Social Security representative (! Form SSA-11 ( request to be Selected as payee ( payee ) manages! The contents ; including confirmation http: //policy.ssa.gov/poms.nsf/lnx/0200502040 received the following as compared to 9 other ssa form 787 sites Report,! You need in the Report section, it only takes a couple of minutes PDFs you open from this may... Endobj Easy to use, nice interface in all their programs the center confirms! Ms 07409.018 must complete the paper version, Features Set 10/10, Ease of use 10/10, Customer 10/10... 'S needs are met disprove the medical evidence in a digital form you! Or bold the text, you can use the text, you can use the.. The document you need in the capability determination yourself as payee ( payee ) who manages the 's. Disability Insurance ( SSDI ) https: //secure.ssa.gov/appslO/poms.nsf/aboutpoms ( last visited Oct. 25 2009!, develop capability using other evidence, per GN 00502.040A, develop capability other... Localized authorization form, to disclose medical information { ^ @: AJ! Disclose medical information their money is spent and how their money is spent and how their money is and!