Representative Payee Report of Benefits and Dedicated Account

ICR 199801-0960-003

OMB: 0960-0576

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0960-0576 199801-0960-003
Historical Active 199707-0960-002
SSA
Representative Payee Report of Benefits and Dedicated Account
Extension without change of a currently approved collection   No
Regular
Approved without change 03/04/1998
Retrieve Notice of Action (NOA) 01/06/1998
  Inventory as of this Action Requested Previously Approved
03/31/2001 03/31/2001 03/31/1998
30,000 0 30,000
10,000 0 10,000
0 0 0

The information collected will be used by SSA to determine whether the payment certified to the representative payee have been used for the beneficiary's current maintenance and personal needs and whether the representative payee continues to be concerned with the beneficiary's welfare. The information is also used to determine if the items and/or services purchased with funds from dedicated accounts are permitted expenditures and if funds are commingled and should be counted as resources.

None
None


No

1
IC Title Form No. Form Name
Representative Payee Report of Benefits and Dedicated Account SSA-6233

  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) 10,000 10,000 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.
01/06/1998


© 2022 OMB.report | Privacy Policy