Information Collection

Applicaiton To Collect A Fee For Payee Services (Private Sector Business)

IC 188037 under ICR 202010-0960-012 · OMB 0960-0719.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0719 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-445 Applicaiton To Collect A Fee For Payee Services (Private Sector Business) Form
Revised PRA Statement - Private Sector.pdf Other-Revised PRA Statement
SSA-445 Application To Collect A Fee For Payee Services (Private SSA-445 - Revised.pdf Form
SSA-445 - Current.pdf SSA-445 (Current) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Applicaiton To Collect A Fee For Payee Services (Private Sector Business)	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 416.640 20 CFR 404.2040

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-445	Application To Collect A Fee For Payee Services (Private Sector)	SSA-445 - Revised.pdf		No		Paper Only
Other-Revised PRA Statement			Revised PRA Statement - Private Sector.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 90	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	90	0	90
Annual IC Time Burden (Hours)	20	5	15
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-445 (Current)	SSA-445 - Current.pdf	10/11/2017

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