REPRESENTATIVE PAYEE EVALUATION REPORT

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
114530	REPRESENTATIVE PAYEE EVALUATION REPORT Form	Migrated

ICR Details

OMB Control No: 0960-0069	ICR Reference No: 198503-0960-014
Status: Historical Active	Previous ICR Reference No: 198408-0960-027
Agency/Subagency: SSA	Agency Tracking No:
Title: REPRESENTATIVE PAYEE EVALUATION REPORT
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/10/1985
	Date Received in OIRA: 03/13/1985
Terms of Clearance: APPROVED WITH THE FOLLOWING CONDITION:IN HHS'S NEXT REQUEST FOR CLEAR ANCE,HHS WILL INCLUDE A DETAILED ANALYSIS (COMPARING FY85 AND 1st AND 2nd QUARTER S OF FY86 DATA) OF:(1)HOW EFFECTIVE THE 624 IS IN DETECTIN THE MISHANDLING OF FUNDS,INCLUDING THE ACTUAL NUMBER OF INDIVIDUALS WH WERE REQUIRED TO USE THE 624,HOW EACH CASE WAS RESOLVED AND HOW MANY I IVIDUALS WERE REMOVED AS REP PAYEES AS A RESULT OF 624 INFORMATION (AN WITHOUT THRID PARTY REFERENCES),(2)THE NUMBER OF THRID PARTY REFERENCE (THOSE THAT LEAD TO 624 USAGE AND THOSE THAT DID NOT) AND THE DISPOS ITION OF THOSE CASES, INCLUDING THE NUMBER OF INDIVIDUALS WHO WERE RE MOVED AS REP PAYEES, (3)A DESCRIPTION OF "UNACCEPTABLE" RESPONSES RE QUIRING FOLLOWUP,AND WHAT RECOURSE IS TAKEN IN INSTANCES OF UNACCEPTAB RESPONSES, AND(4)THE STAFF,FTEs,AND DOLLARS INVOLVED IN THE ADMINISTRA TION OF THE 623 AND 624 (ALL STAGES OF THE OPERATION).IN ADDITION, SSA SHALL DEVELOP DATA ON THE COSTS AND BENEFITS OF ALTERNATIVE METHODS OF IDENTIFYING MISHANDLERS OF FUNDS (INCLUDING ALTERNATIVES SUCH AS PRO FILING MISHANDLERS AND UTILIZING ONLY THRID PARTY INFORMATION) AND PROVIDE THIS INFORMATION WITH ANY REQUEST FOR EXTENTION OF APPROVAL.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/1986	06/30/1986	03/31/1985
Responses	684,000	0	70,000
Time Burden (Hours)	342,000	0	35,000
Cost Burden (Dollars)	0	0	0

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Abstract: THE INFORMATION COLLECTED BY USE OF THE FORM SSA-624 IS NEEDED TO ACCURATELY ACCOUNT FOR THE USE OF SOCIAL SECURITY BENEFITS AND SUPPLEMENTAL SECURITY INCOME PAYMENTS THAT REPRESENTATIVE PAYEES RECEIVE ON BEHALF OF AN INDIVIDUAL. THE AFFECTED PUBLIC IS COMPRISED OF INDIVIDUALS WHO WERE PREVIOUSLY SENT FORM SSA-623, REPRESENATIVE PAYEE REPORT, AND FAILED TO RETURN THE SSA-623 OR DID NOT COMPLETE THE THE FORM PROPERLY.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
REPRESENTATIVE PAYEE EVALUATION REPORT	SSA-624

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ICR Summary of Burden

	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	684,000	70,000	0	0	614,000	0
Annual Time Burden (Hours)	342,000	35,000	0	0	307,000	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 03/13/1985

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