Information Collection

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

IC 188037 under ICR 202405-0960-004 · OMB 0960-0719.

Documents and Forms

Document Name Document Type
Form SSA-445 Applicaiton To Collect A Fee For Payee Services (Private Sector Business) Form
SSA-445 Application To Collect A Fee For Payee Services (Private SSA-445.pdf Form
SSA-445 Application To Collect A Fee For Payee Services (Private SSA-445.pdf Form

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 404.2040 20 CFR 416.640

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.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: 80	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	80	-10	90
Annual IC Time Burden (Hours)	97	77	20
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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