Representative Payee Report of Benefits and Dedicated Account, 20 CFR 416.546 & 640, and 20 CFR 416.635 & 665

Representative Payee Report of Benefits and Dedicated Account

OMB: 0960-0576

IC ID: 9534

Documents and Forms
Document Name
Document Type
Form and Instruction
Other-Revised Privacy Act Statements
Other-Revised Privacy Act Statements
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

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Representative Payee Report of Benefits and Dedicated Account, 20 CFR 416.546 & 640, and 20 CFR 416.635 & 665
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.546 20 CFR 416.640 20 CFR 416.635 20 CFR 416.665

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-6233-BK Representative Payee Report of Benefits and Dedicated Account SSA-6233 (revised).pdf Yes No Fillable Printable
Other-Revised Privacy Act Statements Privacy Act Statement 0960-0576 (revised).docx Yes No Fillable Printable

Income Security General Retirement and Disability

 

6,800 0
   
Individuals or Households
 
   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 6,800 0 0 -24,700 0 31,500
Annual IC Time Burden (Hours) 1,700 0 0 -8,800 0 10,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-6233-BK - Current SSA-6233 (current).pdf 06/07/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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