Advance Designation of Representative Payee (Intranet Version - Paper Form SSA-4547)

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⚠️ Notice: This information collection may be referencing outdated material.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
Form SSA-4547 Advance Designation of Representative Payee (Intranet Version - Paper Form SSA-4547) Form
SSA-4547 - Revised PA & PRA Statements.pdf Other-Revised PA & PRA Statements
SSA-4547 - Revised PA & PRA Statements.pdf Other-Revised PA & PRA Statements
Intranet Advance Designation of Representative Payee Screen Package - Revised.pdf Other-Intranet Advance Designation o
Intranet Advance Designation of Representative Payee Screen Package - Revised.pdf Other-Intranet Advance Designation o
SSA-4547 Advance Designation of Representative Payee SSA-4547 (revised).pdf Form
SSA-4547 Advance Designation of Representative Payee SSA-4547 (revised).pdf Form
SSA-4547(current).pdf SSA-4547 - Current IC Document
SSA-4547(current).pdf SSA-4547 - Current IC Document
Intranet Advance Designation of Representative Payee Screen Package - Current.pdf Intranet Advance Designation of Representative Payee Screen Package - Current IC Document
Intranet Advance Designation of Representative Payee Screen Package - Current.pdf Intranet Advance Designation of Representative Payee Screen Package - Current IC Document

Information Collection (IC) Details

IC Title:	Advance Designation of Representative Payee (Intranet Version - Paper Form SSA-4547)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-4547	Advance Designation of Representative Payee	SSA-4547 (revised).pdf	Yes	No	Fillable Fileable Signable
Other-Revised PA & PRA Statements			SSA-4547 - Revised PA & PRA Statements.pdf	Yes	No	Fillable Printable
Other-Intranet Advance Designation of Representative Payee Screens			Intranet Advance Designation of Representative Payee Screen Package - Revised.pdf	Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 473,052	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	473,052	473,052
Annual IC Time Burden (Hours)	473,052	473,052
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-4547 - Current	SSA-4547(current).pdf	08/21/2023
Intranet Advance Designation of Representative Payee Screen Package - Current	Intranet Advance Designation of Representative Payee Screen Package - Current.pdf	10/27/2022

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