Representative Payee Monitoring

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0151 can be found here:

Documents and Forms

Document Name Document Type
Form G-99A (12-16) Representative Payee Monitoring Form
G-99A (12-16) Representative Payee Report Form G-99A (12-16).pdf Form
G-99A (12-16) Representative Payee Report Form G-99A (12-16).pdf Form
G-99C (12-16) Representative Payee Evaluation Report Form G-99C (12-16).pdf Form
G-99C (12-16) Representative Payee Evaluation Report Form G-99C (12-16).pdf Form
G-106 (Proposed) Statement of Care and Responsibility to Annuitant Form G-106 (11-17).pdf Form
G-106 (Proposed) Statement of Care and Responsibility to Annuitant Form G-106 (11-17).pdf Form
G-99A (Proposed) REpresentative Payee Report Form G-99A (XX-XX) - Proposed.pdf Form
G-99A (Proposed) REpresentative Payee Report Form G-99A (XX-XX) - Proposed.pdf Form
G-99C (Proposed) Represenative Payee Evaluation Report Form G-99C (XX-XX) - Proposed.pdf Form
G-99C (Proposed) Represenative Payee Evaluation Report Form G-99C (XX-XX) - Proposed.pdf Form
Form RL-106 (11-17).pdf Transmittal Letter for Form G-106 IC Document
Form RL-106 (11-17).pdf Transmittal Letter for Form G-106 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Representative Payee Monitoring	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

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	G-99A (12-16)	Representative Payee Report	Form G-99A (12-16).pdf	No	Paper Only
Form	G-99C (12-16)	Representative Payee Evaluation Report	Form G-99C (12-16).pdf	No	Paper Only
Form	G-106 (Proposed)	Statement of Care and Responsibility to Annuitant	Form G-106 (11-17).pdf	No	Paper Only
Form	G-99A (Proposed)	REpresentative Payee Report	Form G-99A (XX-XX) - Proposed.pdf	No	Paper Only
Form	G-99C (Proposed)	Represenative Payee Evaluation Report	Form G-99C (XX-XX) - Proposed.pdf	No	Paper Only

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: 79 FR 58874

Number of Respondents: 6,320	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	6,320	6,320
Annual IC Time Burden (Hours)	1,885	1,885
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Transmittal Letter for Form G-106	Form RL-106 (11-17).pdf	11/19/2020

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.