Non-substantive change 0576

Justification for Non-Substantive Change for Form SSA-6233

Representative Payee Report of Benefits and Dedicated Account

20 CFR 416.546, 416.635, 416.640, 416.665

OMB No. 0960-0576

Minor Revisions to the Collection Instrument

SSA is making the following revisions:

• Change #1: SSA is updating the Privacy Act Statement on the form.

Justification #1: SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. We are revising the Privacy Act Statements, which require changes to remain in compliance.

• Change #2: We added a Note on page 1 above question 1 with instructions to inform the affected payees to complete certain sections of the form.

• Current Language: This report is about the benefits you received for the beneficiary and those which were deposited in the dedicated account during the report period shown above. It also includes any money you reported as saved from a prior report period. Please read the enclosed instructions before completing this form to help you answer each question

• Revised Language: If you are a payee who is exempt from the annual accounting process, only complete questions 6 through 8.

Justification #2: SSA is adding language and instructions to reflect the legislative changes that exempts certain representative payees from completing the entire form.

• Change #3: We are adding language after the second paragraph of the Why You Received This Form section on page 5.

  • Old Language: We must regularly review how representative payees used the benefits they received on behalf of Social Security and/or Supplemental Security Income (SSI) beneficiaries. We do this to ensure the benefits are used properly.

When you were appointed representative payee, you were required to establish a separate (we refer to it as a dedicated) account in which we direct deposited certain past-due SSI benefits. You were informed of the duties and responsibilities of a representative payee, including keeping a record of all the money taken from the dedicated account and receipts for all the items and/or services purchased. We must regularly review this account for additional deposits and to ensure that the items and/or services purchased are in compliance with the law. As part of this review, you need to answer the questions on the enclosed form. It is called Representative Payee Report of Benefits and Dedicated Account, SSA-6233-BK.

You should keep these records (e.g. bank statements and canceled checks) along with receipts for two years from the time you complete the form. Do not submit any records with the completed form. If we have any questions, we will contact you.

• New Language: We must regularly review how representative payees used the benefits they received on behalf of Social Security and/or Supplemental Security Income (SSI) beneficiaries. We do this to ensure the benefits are used properly.

When you were appointed representative payee, you were required to establish a separate (we refer to it as a dedicated ) account in which we direct deposited certain past-due SSI benefits. You were informed of the duties and responsibilities of a representative payee, including keeping a record of all the money taken from the dedicated account and receipts for all the items and/or services purchased. We must regularly review this account for additional deposits and to ensure that the items and/or services purchased are in compliance with the law. As part of this review, you need to answer the questions on the enclosed form. It is called Representative Payee Report of Benefits and Dedicated Account, SSA-6233-BK.

Effective April 13, 2018, the following representative payees are only required to complete questions 6 through 8 of the Representative Payee Report of Benefits and Dedicated Account, SSA 6233-BK:

• natural or adoptive parents of a minor child who reside in the same household

• legal guardians of a minor child who reside in the same household;

• natural or adoptive parents who reside in the same household with an adult child who has a disability; and

• spouses

You should keep these records (e.g. bank statements and canceled checks) along with receipts for two years from the time you complete the form. Do not submit any records with the completed form. If we have any questions, we will contact you.

Justification #3: SSA is adding language and instructions to reflect the legislative changes that exempts certain representative payees from completing the entire form.