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

ICR 200312-0960-007

OMB: 0960-0576

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0960-0576 200312-0960-007
Historical Active 200102-0960-001
SSA
Representative Payee Report of Benefits and Dedicated Account, 20 CFR 416.546 & 640, and 20 CFR 416.635 & 665
Extension without change of a currently approved collection   No
Regular
Approved without change 02/03/2004
Retrieve Notice of Action (NOA) 12/30/2003
  Inventory as of this Action Requested Previously Approved
02/28/2007 02/28/2007 03/31/2004
30,000 0 30,000
10,000 0 10,000
0 0 0

Form SSA-6233 is used to ensure that the representative payee is using the benefits received for the account in compliance with the law. The respondents are individuals and organizational representative payees required by law to establish a separate ("dedicated") account in a financial institution for certain past-due Supplemental Security Income (SSI) benefits.

None
None


No

1
IC Title Form No. Form Name
Representative Payee Report of Benefits and Dedicated Account, 20 CFR 416.546 & 640, and 20 CFR 416.635 & 665 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.
12/30/2003


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