OMB
.report
Search
I4547 (internet version)
Advance Designation of Representative Payee
OMB: 0960-0814
IC ID: 237013
OMB.report
SSA
OMB 0960-0814
ICR 202002-0960-005
IC 237013
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0814 can be found here:
2024-06-07 - No material or nonsubstantive change to a currently approved collection
2023-08-23 - No material or nonsubstantive change to a currently approved collection
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
View Information Collection (IC)
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
Form No.
Form Name
Instrument File
URL
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
Federal Enterprise Architecture Business Reference Module
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
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
3,201,466
3,201,466
0
0
0
0
Annual IC Time Burden (Hours)
320,147
320,147
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
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.