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Federal forms, ICRs, and supporting documents

Information Collection Request

Representative Payee Report (Adult, Child, and Organizational Representative Payee)

ICR 201403-0960-003 · OMB 0960-0068 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form SSA-623 SSA-623: Representative Payee Report (Adult Beneficiaries) Form Modified Available
Form SSA-6234 SSA-6234: Representative Payee Report (Organization) Form Modified Available
Form SSA-6230 SSA-6230: Representative Payee Report (Child Beneficiaries) Form Modified Repair queued
Addendum - 0068.doc Supplementary Document Uploaded 2014-03-12 Available
Supporting Statement 0068 (revised).doc Supporting Statement A Uploaded 2014-06-24 Available
IC Document Collections
IC IDCollectionTypeStatusForm
9006 SSA-623: Representative Payee Report (Adult Beneficiaries) Form Modified
185842 iRPA: Internet Representative Payee Report Other-Online application Modified
185841 SSA-6234: Representative Payee Report (Organization) Form Modified
185840 SSA-6230: Representative Payee Report (Child Beneficiaries) Form Modified
ICR Details
0960-0068 201403-0960-003
Historical Active 201103-0960-004
SSA
Representative Payee Report (Adult, Child, and Organizational Representative Payee)
Revision of a currently approved collection   No
Regular
Approved without change 07/25/2014
Retrieve Notice of Action (NOA) 06/25/2014
  Inventory as of this Action Requested Previously Approved
07/31/2017 36 Months From Approved 08/31/2014
7,149,384 0 6,608,900
1,787,346 0 1,652,225
0 0 0
When SSA determines it is not in beneficiaries' best interests to receive their Social Security benefits payments directly, the Agency will designate a family member, unrelated person, or organization to act as the representative payee for such beneficiaries. Representative payees must account to SSA about how they use these payments on their beneficiaries' behalf; they use forms SSA-623 (for adult beneficiaries), SSA-6230 (for child beneficiaries), and SSA-6234 (organizational rep payees) to do so. This ICR is for three changes to the collection: 1) we are clearing an Internet version of the Representative Payee Report, 2) we are combining all three paper forms under one OMB number, 0960-0068, and 3) we are making minor formatting changes to the first page of the paper forms' instructions.
US Code: 42 USC 1383 Name of Law: Social Security Act
  
None
Not associated with rulemaking
  79 FR 17632 03/28/2014
79 FR 34824 06/18/2014
No
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 7,149,384 6,608,900 0 0 540,484 0
Annual Time Burden (Hours) 1,787,346 1,652,225 0 0 135,121 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
There has been an increase in burden hours. The increase stems from an increase in the number of respondents completing the three paper forms.
No
No
No
No
No
Uncollected
Faye Lipsky 410 965-8783 [email protected]
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
06/25/2014