Information Collection

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

IC 9534 under ICR 200611-0960-005 · OMB 0960-0576.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0576 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-6233 Representative Payee Report of Benefits and Dedicated Account, 20 CFR 416.546 & 640, and 20 CFR 416.635 & 665	Form and Instruction
PRA--0576.doc	Other-Revised PRA Statement
SSA-6233 Representative Payee Report of Benefits and Dedicated Ac SSA-6233.pdf	Form and Instruction

IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.635 20 CFR 416.546 20 CFR 416.640 20 CFR 416.665

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-6233	Representative Payee Report of Benefits and Dedicated Account	SSA-6233.pdf		No		Paper Only
Other-Revised PRA Statement			PRA--0576.doc		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	30,000	30,000
Annual IC Time Burden (Hours)	10,000	10,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.