I4547 (internet version)

Advance Designation of Representative Payee

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0814 can be found here:

Documents and Forms

Document Name Document Type
iClaim Advance Designation of Representative Payee Screen Package.pdf Other-iClaim Internet Screens
mySSA Advance Designation of Representative Payee Screen Package_9.26 Alternative V1.3.pdf Other-mySSA Internet Screens
Advance Designation of Representative Payee Annual Notice.pdf Other-Annual Notice
Advance Designation of Represenative Payee Receipts final 08.20.pdf Other-Payee Receipts

Information Collection (IC) Details

IC Title:	I4547 (internet version)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-iClaim Internet Screens	iClaim Advance Designation of Representative Payee Screen Package.pdf	Yes	Yes	Fillable Fileable Signable
Other-mySSA Internet Screens	mySSA Advance Designation of Representative Payee Screen Package_9.26 Alternative V1.3.pdf	Yes	Yes	Fillable Fileable Signable
Other-Annual Notice	Advance Designation of Representative Payee Annual Notice.pdf	Yes	No	Paper Only
Other-Payee Receipts	Advance Designation of Represenative Payee Receipts final 08.20.pdf	Yes	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,201,466	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
Annual Number of Responses for this IC	3,201,466	3,201,466
Annual IC Time Burden (Hours)	320,147	320,147
Annual IC Cost Burden (Dollars)	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.