Application to Collect A Fee for Payee Services

OMB 0960-0719

The Social Security Administration uses information it collects on Form SSA-445 to determine whether to authorize or deny permission to collect fees for payee services. The respondents are private sector businesses or State and local government offices applying to become a fee-for-service organizational representative payee.

The latest form for Application to Collect A Fee for Payee Services expires 2021-02-28 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form SSA-445 Application to Collect A Fee for Payee Services (State/local government offices) Form
Form SSA-445 Applicaiton To Collect A Fee For Payee Services (Private Sector Business) Form
Supporting Statement - 0719 (Final).docx Supporting Statement A
Application to Collect A Fee for Payee Services (State/local government offices) Form
Applicaiton To Collect A Fee For Payee Services (Private Sector Business) Form

All Historical Document Collections

202405-0960-004 Approved without change	Revision of a currently approved collection	2024-06-21
202010-0960-012 Approved without change	Revision of a currently approved collection	2021-01-28
201707-0960-011 Approved without change	Revision of a currently approved collection	2017-11-14
201407-0960-006 Approved without change	Revision of a currently approved collection	2014-10-06
201109-0960-014 Approved without change	Revision of a currently approved collection	2012-01-19
200809-0960-006 Approved without change	Revision of a currently approved collection	2009-02-13
200512-0960-011 Approved with change	New collection (Request for a new OMB Control Number)	2005-12-27

OMB Details

Application to Collect A Fee for Payee Services

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Form SSA-445

Application to Collect a Fee for Payee Services (State/local government)

Paper Only

Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.