Information Collection

SSA-6234: Representative Payee Report (Organization)

IC 185841 under ICR 201812-0960-005 · OMB 0960-0068.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0068 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-6234 SSA-6234: Representative Payee Report (Organization) Form
Rep Payee Insert.pdf Other-Information Insert for Paper F
Revised PA and PRA Statements.pdf Other-Revised PA and PRA Statements
SSA-6234 Representative Payee Report (Organization) SSA-6234-F6 - Revised.pdf Form
SSA-6234-F6 - Current.pdf Current SSA-6234 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SSA-6234: Representative Payee Report (Organization)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.2065 20 CFR 416.665 20 CFR 404.2035 20 CFR 404.635

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	SSA-6234	Representative Payee Report (Organization)	SSA-6234-F6 - Revised.pdf	No	Fillable Printable
Other-Information Insert for Paper Forms Re New Internet Option			Rep Payee Insert.pdf	No	Paper Only
Other-Revised PA and PRA Statements			Revised PA and PRA Statements.pdf	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 566,072	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Previously Approved
Annual Number of Responses for this IC	566,072	-153,612	719,684
Annual IC Time Burden (Hours)	141,518	-38,403	179,921
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-6234	SSA-6234-F6 - Current.pdf	04/12/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.