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Application for Substitution of Payee and Duties As Representative Payee (Individuals)
Application to Act as Representative Payee
OMB: 3220-0052
IC ID: 33865
OMB.report
RRB
OMB 3220-0052
ICR 201308-3220-001
IC 33865
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0052 can be found here:
2023-03-28 - Revision of a currently approved collection
2019-12-30 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
Form RB-5
Application for Substitution of Payee and Duties As Representative Payee (Individuals)
Form and Instruction
AA-5 Application for Substitution of Payee
Form AA-5 (01-04).pdf
Form
RB-5 RB-5 Booklet; Your Duties as Representative Payee- Repre
Form RB-5 (3-98).pdf
Form and Instruction
AA-5 (proposed) Application for Substitution of Payee
Form AA-5 (proposed).pdf
Form
RB-5 (proposed) RB-5 Booklet: Your Duties as Representative Payee-Repres
Form RB-5 (proposed).pdf
Form and Instruction
Form SSA-11-BK (08-09).pdf
SSA-11-BK (8-2009)
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Application for Substitution of Payee and Duties As Representative Payee (Individuals)
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 266.7
20 CFR 266.6
20 CFR 266.9
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
RB-5
RB-5 Booklet; Your Duties as Representative Payee- Representative Payee's Record
Form RB-5 (3-98).pdf
No
Paper Only
Form
AA-5 (proposed)
Application for Substitution of Payee
Form AA-5 (proposed).pdf
No
Paper Only
Form and Instruction
RB-5 (proposed)
RB-5 Booklet: Your Duties as Representative Payee-Representative Payee's Record
Form RB-5 (proposed).pdf
No
Paper Only
Form
AA-5
Application for Substitution of Payee
Form AA-5 (01-04).pdf
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
RRB 22 - Railroad Retirement, Survivor, and Pensioner Benefit System
FR Citation:
75 FR 43727
Number of Respondents:
11,500
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
13,725
0
0
0
0
13,725
Annual IC Time Burden (Hours)
12,112
0
0
0
0
12,112
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
SSA-11-BK (8-2009)
Form SSA-11-BK (08-09).pdf
08/12/2013
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.