REPORT OF NEW INFORMATION FOR BENEFICIARIES WHO HAVE A REPRESENTATIVE PAYEE (GROUP PAYEE SITUATIONS)

ICR 198111-0960-001

OMB: 0960-0180

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0960-0180 198111-0960-001
Historical Active 198001-0960-001
SSA
REPORT OF NEW INFORMATION FOR BENEFICIARIES WHO HAVE A REPRESENTATIVE PAYEE (GROUP PAYEE SITUATIONS)
Extension without change of a currently approved collection   No
Regular
Approved without change 12/08/1981
Retrieve Notice of Action (NOA) 11/10/1981
  Inventory as of this Action Requested Previously Approved
01/31/1984 01/31/1984 01/31/1982
30,000 0 30,000
3,000 0 3,000
0 0 0

SECTION 205(A) AND (J) OF THE SOCIAL SECURITY ACT PROVIDES FOR INFORMATION REGARDING REPORTING OF EVENTS WHICH MAY AFFECT THE BENEFICIARY'S ENTITLEMENT TO BENEFITS. THIS FORM IS USED BY INSTITUTIONAL REPRESENTATIVE PAYEE TO REPORT ANY CHANGES.

None
None


No

1
IC Title Form No. Form Name
REPORT OF NEW INFORMATION FOR BENEFICIARIES WHO HAVE A REPRESENTATIVE PAYEE (GROUP PAYEE SITUATIONS) SSA-3159, (7-79)

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 30,000 30,000 0 0 0 0
Annual Time Burden (Hours) 3,000 3,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
11/10/1981


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