Information Collection

Representative Payee Survey

IC 33701 under ICR 202512-3206-002 · OMB 3206-0208.

Documents and Forms

Document Name Document Type
Form RI 38-115 Representative Payee Survey Form and Instruction
Form RI 38-115 Representative Payee Survey Representative Payee Survey Form and Instruction
RI 38-115 Representative Payee Survey RI38-115_2025_08_Revised.pdf Form and Instruction
RI 38-115 Representative Payee Survey RI38-115_2025_08_Revised.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Representative Payee Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	RI 38-115	Representative Payee Survey	RI38-115_2025_08_Revised.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title: OPM/Central-1	FR Citation: 73 FR 15013

Number of Respondents: 11,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	11,000	0	11,000
Annual IC Time Burden (Hours)	3,667	0	3,667
Annual IC Cost Burden (Dollars)	119,633	21,183	98,450

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.

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